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So she was an integrative therapist, the type of therapists that the research indicates has the best outcomes. Trauma has a way of impairing what is known as "locus of control."  My approach is to allow clients to select the type of therapy they want to be involved with in a collaborative fashion that is based on the best available evidence base. We use an outcome based, deliberate approach where we use a feedback informed instrument in every session were Tx progress is assessed from the client's subjective experience not imposed on them from an external source, keeping in mind the a general goal of therapy is to assist in the restoration of an internal locus of control and internal locus of evaluation so that they are the ones making meaning- it is not interpreted by a therapist, We do everything possible to allow the client to feel in control of the therapy process as a metaphor for gaining increased control over their lives.

Our therapists are cross-trained in a variety of approaches, cognitive, behavioral, affective (emotional), somatic and spiritual. All of the therapies, per se, are experiential. There are also psychoeducational and didactic components that clients can participate in. The client, not the therapist, decides when to change the treatment approach based on the session-to-session assessments guided by the client.

We are not interested in promoting one approach over another. The research (which as licensed professionals, we are obliged to follow) indicates that there is no statistical difference in one approach over another, that relational aspects are more important than treatment approach, that retention in therapy is based on collaborative relationships with clients, that clients need to experience movement in therapy or what is more commonly known as therapy progress, and that offering an array of services (resources for basic needs, medical care, child care, etc.) is more important that the treatment approach.  I would add cultural sensitivity to that list. We use the best research and scientific models for our treatment.  We are obliged to do so under our accreditation and funding sources. A personal anecdote from a third party source is not science or evidence based. EMDR is an evidence based treatment and all our staff are trained in that approach by EMDRIA approved trainers.  Our clinicians are also trained in one of the following:

I'm glad your experience indicated that the clinicians in your agency were flexible enough to try a different approach when the client was not making progress. That integrative style is exactly what we espouse. Thank you for reinforcing that with your example. it's much better in the interest of client outcomes for the therapist to be trained in a number of approaches instead of calling the client "resistant" to the therapist's inflexibility.

Last edited by Jane Stevens (ACEs Connection staff)

The biggest problem in my mind was that the agency providing the TF-CBT used interns, who left after brief stints.  My CASA kid had 3 therapists in the system and was about to have a 4th, before I got her out.   Thus the relational component was totally undercut.

My frustration is when there is a kid who is suicidal or out of control or shut down, whatever, and youve given TF CBT 3 times, and especially if the kid is TRYING (like my CASA youth who even agreed to a 3rd CASA at 16!!)  and the psychological problem is still there, unchanged, you have to think of something else to try.  Kids who repeat what is not working simply age out of the system as WRECKS.  This is unconscionable when other therapies exist, IMO.

Another big evil is NOT diagnosing things formally which would compel a more serious therapeutic approach.  Example, RAD was talked about to old CASA but never in official ppwk.  Dissociation witnessed by me was pooh poohed.  They want the # of clients they serve to be high and not lose the revenue to an outside provider.

I still feel RAGE at that agency. 


I'm sorry you had that experience. Our agency provides services free, except for the custody exchange program, regardless of income through several funding sources. I do remember my days working with managed, care third- party payers. I was like walking a tight rope.  I developed a "script" where I had to say, "the client is making progress and will greatly benefit from continued treatment." This was in a residential substance use disorders treatment facility, When the insurance companies started dictating what type of therapy we performed, from their manual, I left. Another reason for leaving was the administration forbade me from working on what was known in substance treatment as Adult Children of Alcoholics and other Dysfucntional Familes  (ACoA) issues. I saw them as unprocessed trauma issues that could be treated in a co-occurring (dual diagnosis) approach. This was in the early 1990s and that facilities philosophy was that addictions are primary, progressive disorders and that looking at underlying reasons was enabling further use and excusing the addictions. We've come a long way since then and the Minnesota Model of addiction is now trauma informed. 

I now work with children and families directly on trauma and thank goodness, we don't have to deal with our state's version of Medi-Cal, Medicaid. They are very hard to even bill for. I was also trained as a medical assistant with a focus on trauma and billing. It's a relief to no longer have to reduce human suffering to an ICD or DMS code to get paid to keep the doors to the agency open. We still have to jump through a few hoops for accreditation and funding, but we are not dictated how to do our work. I'm glad you found a clinician who was able to help. 

My lunch is almost over, so I need to go.


Being Trauma Informed is supposed to hold prominent avoidance of re-traumatizing.  There is nothing more discouraging and retraumatizing in my mind than trying your hardest, giving it everything you've got to recover, trusting the "experts" only to finally realize that the "experts" don't really know all that much and to come to know what you have been given as "therapy" doesn't have a snowball's chance of helping you.  In fact, it made you a lot worse.    Too many innocent lives lost for me.  Too many kids that are doing what they can to recover and be productive in society being led down a path that isn't helping them.  It should not be this way and it doesn't have to be except that we have given up on everything that makes us human, our ability to empathize and take perspective and to have integrity and be honest with each other but tactful, we have given all this up for far too long and it is going to take lifetimes to ever find our way back I think.  I wish everyone in society understood how a baby develops in context of close relationship with the mother and then others in a socially structured, society.   Most of us have no idea how babies or personalities develop in context of relationship, for good or for bad.  I didn't really know until 10 months ago ---- after reading almost 200 books about infant development and personality formation and object relations and even psychodynamic psychotherapy, I didn't understand until I stumbled across concepts of dissociation, implicit memory and disorganized infant attachment.   When all the dust settles a couple centuries from now and we all finally decide we want to live in a non-violent world, babies have to be cared for properly.  

Couple articles on Resilience:

Infant frontal EEG asymmetry in relation with postnatal maternal depression and parenting behavior --   (The baby's brainwaves develop around the relational input it receives).

Last edited by Lisa Geath

Hi Laura

Are these the CALCASA people you are writing about? I wondering before about the level training and experience that the TF-CBT therapists had and who it was who trained them?  I think if psychiatrist Judith Cohen, the originator of TF-CBT, had been the therapist, there may have been different results. Reactive Attachment Disorder should only be diagnosed and treated by an infant mental health specialist, and one of the ethical standards all mental health professions is to not work outside one's scope of practice and to make proper referrals when clients present with challenges beyond one's training.

I'm also a graduate of the John Hopkins Bloomberg School of Public Health, and am seeing so much sloppy handling of the SARS-CoV-19 pandemic, it's disturbing. We're finding out the contract tracers are being hired based on cronyism and nepotism, not on their professional backgrounds. That makes it more important than ever for us, as citizens, to do our part. 

Last edited by Jane Stevens (ACEs Connection staff)

We  need court advocates. We have them at our agency. They perform an invaluable, and God Bless, they are on-call 24 hours a day. They serve the dual role of court advocate and first responders.  Thank you for your work. I'm not familiar with your agency, If you would like to post some information, I'd be interested in what your agency does. We do not work with children who have sexually assaulted. We do work with exposed children, mostly through witnessing intimate partner violence. We do, however, work with adult survivors of childhood sexual assault. ACEs apply to then also. I work mostly with children when I'm not the training role. Believe, I know the limits of any type of talk therapy with that population.  In my spare time, I'm working with someone out-of-state, on program development for male survivors of sexual assault, That group is more "invisible," though we know there is a significant number of survivors. Here's one such story that has been weighing on my heart lately. I think it demonstrates the consequences of assault don't end with the original incident.

Warning: graphic description of sexual assault

I'm not a survivor of sexual assault myself, just a person of conscience who experiences moral injury when I hear of any type of abuse- human or animal. Clinicians who work with survivors, do need to keep some level of composure when working with clients, and if they ever become inured to witnessing these recounts of abuse, they need treatment themselves. That treatment could involve stepping up their own self-care, more consultation, or seeking the services of a therapist (not a colleague) themselves. It's the very definition of compassion fatigue.



Desperate adults who were abused as kids (for way too many beginning in infancy) from the neglect of not having the diaper changed, from having a bottle propped as the feeding, never being looked in the eyes with kind eyes, and having a cell phone or tablet shoved in our face to the rage that comes next from the parent after a simple infant cry indicating a basic need that would have always been answered in the past when we lived in a tribal setting....  

We want and need people who provide "therapy" to understand infant brain development.  We do not want to go to a big ten school to try to find someone who can help only to find out we get to be put on a pill mill by people who profess to be amazing experts but can't help us and smugly tell us that our ideas are kind of stupid because it wasn't written up in their medical textbook.   Am I a little irritated?  Yes.  I see too many people desperate to recover falling through the cracks and being blamed for not trying hard enough when the real truth is ---- having a brain that got wired for fear and terror and that operates in mostly delta and theta brain waves and dissociation and nothing is integrated with a massive right hemisphere predominance starting from the time you were in the womb doesn't just remodel itself with these simple therapies of talk or even EMDR as an older adolescent or adult.  When I took the Nature of Forgetting - Sebern stated that even Somatic Experiencing would not be enough for these people.  These are the people where the trauma problem is going from generation to generation through massive avoidant or more commonly Type D disorganized attachment.  These are the people who end up homeless or in prison and who have all the generational trauma.  Forgive the typos --- I gotta run.  

Last edited by Lisa Geath

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