Intermountain Moment: Safety first! Working with trauma-affected individuals

 

 

 

Safety. It's something that many of us take for granted. But for many of the clients Intermountain works with, and especially the trauma-affected children that come to us in our residential program, safety is certainly not a "given."

While it may seem odd to those who have not experienced childhood trauma or adversity, an individual who felt unsafe as an infant or child can have a disruption in their relational, physical, and emotional development that inhibits their brain's ability to accurately interpret their world. Stress hormones can flood their brain and send them into a state of re-traumatization (sometimes referred to as "being triggered," but it's more like a switch has been flipped or the floodgates on an emotional dam have been released!) that makes it impossible for them to engage in higher level thinking tasks while in that heightened emotional state. Everything in their brain is telling them they should rightly fear for their life and either run, fight, or shut down ("play possum") in order to survive that moment.

What might set off a state of re-traumatization differs from individual to individual based on their experience. The response that care givers, friends, family members, and hopefully faith communities can react with is to establish felt safety. This can be hard to learn, as those who are re-traumatized in the moment and are feeling unsafe often express it in unsafe ways! This, in turn, can cause those of us caring for these individuals to feel unsafe and have our own fight-flight-freeze response. Only by being consciously aware of our responses, taking a moment to regulate ourselves, can we then provide a response that will communicate safety and calm to the re-traumatized individual we are seeking to help.

When seeking to establish or re-establish felt safety it is important to remember a few things:

1. "Felt" safety is just that... Ask, "What is going to FEEL safe to the individual?" This is not the time to argue or convince... remember the individual is not in command of their executive functioning or reasoning skills anyway! Telling someone, "You are safe... no one is trying to hurt you!" is not as powerful as checking your posture, your tone of voice, and the setting to see what can be done to communicate safety.

2. Understand that when someone is traumatized or triggered, their responses will be more “all or nothing”; extreme; black or white; friend or foe. They may not even be seeing you as the "safe person" you are, but rather might be seeing you as their abuser. Do not take offense! This moment will pass.

3. Give simple, direct instructions... one at a time. Your anxiety in the situation may lead you to want to give more than one instruction at a time or pile on words (that's what I tend to do!). So, an example would be: "I can see something has upset you... please take a deep breath with me." Repeat that as many times as needed to get them to slow down and take a deep breath. Taking deep breaths is a scientifically proven way to help move someone from the flight-flight-freeze response to a more regulated position from which they can be calmed and reasoned with. After you get them to take a breath, then you can continue with other simple, direct instructions related to safety.

I have found that having to step in for a child to help them regulate from a re-traumatizing experience is almost always embarrassing for them, bringing up a sense of shame or brokenness. As ML Rutherford suggests in the video above, ultimately that child or individual you are working with will thank you for demanding that they be safe and that you ensure a safe environment be present for them, as well. This might involve certain structures in place or circumstances that apply to them that don't apply to other children. If these requirements always relate back to safety (especially that FELT safety, remember!) and don't appear arbitrary or punishing, these limits communicate the LOVE we want to express to those who are trauma-affected.

Ultimately, as ML says, these children (and older individuals!) will thank you for your care and understanding of their needs. And, if we can teach them self-awareness about how they can establish safe boundaries for themselves and the ways they get "triggered" and can either prevent or move through those events, we will have brought a greater sense of healing and wholeness to them that gives them a sense of dignity and ownership of their emotional world.

Final note: After writing this post, I spent the better part of my Friday in the ER with someone very close to me... had I not remembered these principles above, the situation could have gone from bad to worse very quickly. Those of you reading this that are working with trauma-affected people, especially close family members, I know something of what you are going through! Hang in there! God's grace is strongest in our areas of greatest need. Don't give up on yourself and thank you for being there for those that need you because you understand their trauma. Blessings, Chris.

 

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Chaplain Chris, Thank You for this important 'healing tool'[s] ! ! !  Two years after [failing to prevent, not accepting an apology prior to, and subsequently witnessing] my mother's handgun suicide [with the Bible in one hand, gun in the other], I subsequently witnessed/assisted at an 'Industrial accident' before I  had graduated High School--in one of the safest industrial environments I ever worked in my entire life-so far. But 'Accident Prevention' remains a goal, as I note many 'hazards' ...

Adversity is often generational, and should be approached with compassion for the children and their parents.  Based on the study of Learned Helplessness, there is a disconnect between adversity and a normalization of lived experience.  Kids don't know what adversity is.  Safety is the way a victim of trauma comes to a new belief.  Adults that work with children who are reactive to behaviors do not show a child it is safe to come to a new belief because kids who need the most love ask in the most unloving ways, and a negative response confirms what they already believe.  Many of our children don't know that what they experienced in their past was wrong.  It was their normal, and when placing these children in foreign homes, children recreate what they know.  After all, it was their normal.  So, learned helplessness is caused from repeated adverse experiences and can only be changed through learning a new experience with repetition.  When everyone else has left, be the one who stays!

Chaplain Chris - thanks for taking on the topic of felt safety and the concept we at ATN describe as "going in after" a kid -- stepping into their volatile dysregulation to help give them structure and safety...and then being with them through the shame.  It's what we teach parents to do when they're able and how they can prepare themselves (through self-care and addressing their own emotions before the crisis moments).  The trust that is build with someone willing to do this in the life of a traumatized person is so helpful to creating their capacity for resilience!

I was one of these children who wished someone would save me from my very abusive parents.
Nobody did.
Now at age 70, after hundreds of hours of different therapies and antidepressants, I still have not only vivid and detailed memories also genetic makers (epigenetic methylated Genes) related to childhood trauma.
Now, I am writing my second book, title “The Imprint” documenting how little progress, in spite of years of “progressive” psychological knowledge, has changed child abuse prevention and how little is known about long-term-consequences.   

Thank you for sharing your experience Sieglinde. I remember pining for a rescue too. Luckily, my mom allowed a letter to my grandparents to be mailed and therein was my request to live with them. I got lucky (somewhat although my new home was fraught with other challenges) but my healing journey since, like yours, has been long and arduous. I, too, have tried many therapies, therapists, and modalities to heal mentally, emotionally and physically as my body is quite tight, rigid and uncomfortable to be in most of the time as a result of complex PTSD. Medication has never been an ally as I prefer and gravitate toward a more holistic approach: Regular massages and several other new-to-me techniques like T.R.E. (Trauma Releasing Exercise by Dr Berceli) and counter strain from physical therapy philosophy are helping. I haven't heard of the epigenetic methylated gene expression concept that you briefly mentioned; perhaps you will share more with the ACES community when the time is right. I am very interested in research that explains how trauma affects cognition and learning in children and adults. I understand your yearning for this and I believe we are getting there. #ConceiveBelieveAchieve 

My son is 15 years old and has experienced significant stress from birth (probably even in utero). The staff at his school tell me that they can't really help him therapeutically because he won't "explore the cause" of his emotions. He will talk about surface stress, but  is "resistant to go deeper".

The thing is, "the cause" is his Dad and it is compounded by the fact that he died  in a motorcycle accident.  This happened 1 week after his Dad finally apologized for one thing he did and agreed to start going to therapy with him. He saw this as the first step toward resolving things. He has been in and out of therapy since he was 3. He now finds it to be a waste of time because he feels it never worked. 

I guess I wonder if this is to be expected and what other approaches the counselor can take besides pushing him to talk about his Dad and his life with him. I wonder if he just isn't able to verbalize the hurt and maybe he shouldn't be expected to in order to heal...??  We haveha meeting next week to discuss some of these issues and wondered if you had any suggestions I could provide?    

P.S. This is a trauma informed school, but my son doesn't seem to be conforming to their trauma informed model. 

Advice or suggestions?

Dawn

Dawn,

I am so sorry for you and your son's loss. There's a lot to unpack there, it sounds like. I believe you are running into an issue I have had with my children and their trauma history, even with churches, schools and other settings that are supposedly trauma-informed. Knowing the impact of trauma on the developing brain and being able to recognize the signs and symptoms (the first 2 parts of a trauma informed approach) doesn't necessarily lead to an empathetic response from caregivers and those who find themselves in positions of authority over your son. The behavioral health model and a compliance agenda are really hard to break free from... I fall into the same trap as a dad and a chaplain, because most of the time my default is simply "I want you to do what I told you," not "I want to understand your motivations and difficulties in relationship better" so I can help.

 

15 is a hard enough age, even without trauma-affect issues. When I was that age I fought going to counselors because it didn't "work" for me either! (truth: my image of masculinity at the time didn't leave a lot of room for talking about feelings and things I didn't feel I could change). It might work to talk with your son about what would constitute therapy/counseling "working" for him... that is, what is his goal, should he continue counseling? He's at an age where he'll want to have more ownership of his life and the decision-making process... maybe he can work with his counselor on some agreed upon goals?

 

I would assume that the school saying "they can't help him therapeutically" is a response to some behaviors that are not in keeping with their expectations? Is he on an IEP? In their defense, if they feel he isn't engaging in the relational/therapeutic side of what is being offered, perhaps they have fallen back on the easier compliance mindset (for example: "Ok, if you don't want to take a break and talk with someone about what is really going on for you right now, I need you to at least be willing to sit quietly at your desk and work on the assignment.")

 

I would suggest that you go into the meeting with the school with an approach that you are going to be working with the school to find an agreed upon goal for the outcomes that you, your son, and the school can all agree to. Then, once the goal is clear, you can advocate for your son on what supports need to be in place for him to be expected to work reasonably toward those goals.

 

Dawn, that's about all I can really offer as far as "advice" and that's just coming from my own experience in working with schools and IEPs and trying to come together with educators on finding a way forward when there is a sense of competing agendas. I hope it helps!

 

Chris

Dawn Miller posted:

My son is 15 years old and has experienced significant stress from birth (probably even in utero). The staff at his school tell me that they can't really help him therapeutically because he won't "explore the cause" of his emotions. He will talk about surface stress, but  is "resistant to go deeper".

The thing is, "the cause" is his Dad and it is compounded by the fact that he died  in a motorcycle accident.  This happened 1 week after his Dad finally apologized for one thing he did and agreed to start going to therapy with him. He saw this as the first step toward resolving things. He has been in and out of therapy since he was 3. He now finds it to be a waste of time because he feels it never worked. 

I guess I wonder if this is to be expected and what other approaches the counselor can take besides pushing him to talk about his Dad and his life with him. I wonder if he just isn't able to verbalize the hurt and maybe he shouldn't be expected to in order to heal...??  We haveha meeting next week to discuss some of these issues and wondered if you had any suggestions I could provide?    

P.S. This is a trauma informed school, but my son doesn't seem to be conforming to their trauma informed model. 

Advice or suggestions?

Dawn

Hi Dawn,
It is so distressing when your child needs assistance/support/etc and it is difficult or impossible to access.

Our boys also needed assistance in school and we found that a Special Education advocate was very helpful.  We never went to a school meeting without an advocate - that person knew the rules/laws and we could stay in the role of parents and stay focused on our child's unique educational needs. I am so sorry you and your son are going through this very difficult time - my heart is with you.

Its good to recognize that ACEs science has evolved and we now understand that "talk therapy" is not typically useful for those who are healing from trauma. This article: AC The Body Keeps Score: early childhood trauma might be informative. 

For additional understanding about childhood adversity / trauma, maybe the school staff might find this article: ACEs Too High: ACEs 101 informative. 

Wishing you and your son all the best.
Karen

Thank you, Karen. I will look at both resources. I do take a Special Education advocate with me to every meeting. The school is Trauma informed so, I'm a bit surprised. The past 2 years had gone so well and we were making great progress, then they moved him downstairs to the HS level and essentially pulled the rug out from under him (and us too). 

All new teachers, new Counselor, new Paras, no contact with any of his identified support people. The majoriym of his class stayed up in Middle School and his closest friend is in different classes. 

None of his accommodations were put into place, after a month he still hadn't started with his tutor, they took the Chromebooks away from the students (he uses them for Assistive Tech), he lost his Leadership Team and Student Council because his home district decided to co-op transportation, meaning his schedule no longer allowed to stay later once a week, all of a sudden he was expected to complete 9th grade level work in order to get his HS Diploma (he was at 4th grade Math and 5-6 grade Reading). Now he is expected to take Algebra 🙄

And they made all these changes with absolutely no prep work with him. No wonder he went into "freeze" mode and shut down, struggling to keep going to school and eventually refusing after a month. (When he was 2-3, he told me the only way he made it through weekends at his Dad's house was to "lose his voice". 

All of this while experiencing significant sleep issues (that were labeled as manipulation), but after demanding a sleep study was dx with sleep apnea and close to 35 arousals per hour. So, he spent the majority of the night in the lowest level of sleep causing him to feel like he was getting NO sleep. And the Dr refused to prescribe homebound until we got his Cpap machine and he was mentally prepared to face the stress at school....because again, he was manipulating me. 

So incredibly frustrating....

 

 

Dawn - It sounds to me like you know the ways in which his school has not followed through on their trauma-informed strategies - by pulling all his supports and not helping him make the transition.  I wonder what their reasoning for this was (could be something as simple as personnel changes or need for extra space). Please go advocate for them to find a way to repair this.  When we train schools to become trauma-informed we make it clear that it is NOT important, or necessary, to know the details of any child's trauma, or even know for sure that a child has experienced a certain trauma or number of ACEs.  Trauma-informed strategies of building relationships, helping with regulation, keeping the environment calm and safe, making transitions slowly, carefully and with supports are all T-I strategies.  The thing that is really important for the school to do now is to try to repair the relational environment that has so drastically changed for him.  Asking a person impacted by trauma to "go deeper" during a time when they are feeling less safe/secure -- move to new floor with new teachers and harder academics, will never work.  If the staff is confused about why he's shutting down/freezing, they need to review their trauma-informed training, not look for something deeper in him.  

As his parent, though, I would be planning, after he gets back to a more healthy equilibrium, a way to help him find the therapies he needs to process through what has happened to him.  It sounds as if counseling itself - because of the death of his father right when counseling started -- is a trigger.  Maybe you can locate experiential trauma therapy in your community and he can get involved in that sooner rather than later.  At 15 the key is to give him as many self-regulating tools as possible so he can help re-center himself when the environment goes topsy-turvy like it did for him at school right now.

Hang in there - you're not alone...there are many of us parenting children who need this level of support!

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