Thursday, February 21, 2008

Conference Presentations

Are you attending the CWLA or BACW annual conferences? I’m presenting at both- come by and say hello!

FEBRUARY 25-27, 2008

B2 Challenges and Rewards of Trauma-Informed Treatment
Room: Washington 5
This presentation explores the joys and struggles of implementing and providing trauma-informed, relationship-based treatment through Risking Connection, training, and the Restorative Approach model. It includes methods, common concerns and responses, indicators of trauma-informed
care, and agency/management strategies. Trauma-informed treatment provides better outcomes for children and better working environments for staff.
Presenter: Patricia Wilcox, Vice President of StrategicDevelopment, Klingberg Family Centers, New Britain, CT

BACW Annual Conference
Listening and Responding to the Voices of Our Youth, Our Legacy
Renaissance Harborplace Hotel
Baltimore, MD 21202
March 2-4, 2008

A-5 The Trials and Tribulations of Trauma-Informed Treatment
This workshop will present compelling evidence that treatment becomes more effective by replacing traditional systems with relationship-based approaches. The workshop will discuss specific training methods to enhance staff understanding of youth and trauma while suggesting solutions.
Moderator: Patricia Simmons, Philadelphia, PA
Presenters: Patricia D. Wilcox, MSW-LCSW, Vice-President Strategic Development, Klingberg Family Center, New Britain, CT; T’Kai Howard, MSW-LCSW; Coordinator Nia
Sage Therapeutic Group Home, Klingberg Family Center, New Britain, CT

See you there!

Monday, February 18, 2008

Inner Connection to Others

In Risking Connection® we teach that a childhood full of attachment disruptions and trauma impairs development of basic self capacities. Self capacities are those core skills that allow us to hold onto who we are no matter what happens, to survive adversity, and to handle what life brings us. Risking Connection® identifies three core self capacities: the ability to form and maintain an inner connection to others; the sense of being worth the air you breathe; and the skills of feelings management. These self capacities develop through connected, attuned relationships with others. When a person does not have a chance to develop these skills, all set backs large or small throw them into extremes of intolerable feelings. They do these things we call "symptoms"- hurt them selves, hurt others, retreat, to escape the intolerable feelings because they know no other options.

The skill of "form and maintain an inner connection to others" is often mistaken for the skill of just making a connection with others. Our kids are not good at making connections: they do not trust, they have been hurt, they protect their hearts. They often do not know social skills of conversation and reaching out to others. They are scared by being close. Just making a connection with them is often hard enough.

But we must go a step farther. In order to survive life, we also have to be able to keep a sense of our connection with others even when they are not physically present. Even when we are alone, we must be able to remember (and actually feel) that someone loves us.

Inner connections with others are formed through repetitive, trustworthy, dependable attuned relationships with loving others. With our own children we work hard to create inner connections. When we will be away from them, whether for a school day or a longer trip, we write notes, call, leave pictures, leave presents, use many rituals to covey: even when I am not with you, you are in my heart and I love you.

The kids we work with have not had this care and constancy. And in fact people have disappeared from their lives unexpectedly. Others have not acted lovingly towards them.

But why is it so important to have inner connections with others?

If not, whenever you are physically alone, you will feel desperately and completely alone. And scared.

When someone leaves work for the weekend you will be certain that you will never see them again.

When something goes wrong, you will not be able to tell yourself: that’s okay, my mother still loves me.

When some one treats you badly you will not be sure that anyone will come to your defense. Or, therefore, that you are worth defending.

We generally think of inner connections as being able to summon the presence of a certain loved one when they are not there, to give ourselves reassurance and courage. And that is a big part of it.

But inner connections also become the voice with which we talk to ourselves, what we say to ourselves ("it’s okay, you’ll get past this" or "you stupid idiot, you messed up again"). And thus they shape our view of ourselves and of the world.

One of our faculty trainers Richard Nicastro ( gives this example. A client once described to him the difference between how she imagined the world inside his head and the actuality of how she experienced the world inside her own head:

My client’s description of my internal experience (My room):

Think of a room that you admire, maybe one that you know or visited. Picture the room filled with items you love, items that make you feel warm, bring you comfort, joy, and excitement. People that you love and admire can stay or leave in your room as you see fit. These loving others can sit next to you if you want, they can converse and are responsive to your needs. They can even sit quietly or leave if you need them to. Whenever you’re upset, you have access to these people. Their presence gives you comfort. In this room you’re basically in charge of what happens. You love existing in this place and you know that you belong here.

My client’s description of her internal world (her room):

Now imagine a different sort of room. One of those rooms that exist in the basement of a house that no one wants. It’s cold, dark, and damp in my room. Everything feels unclean in this room. My room is barren and inhospitable. People come and go as they please. People I wish I never knew. They are unpredictable. At times violent and cruel, at other times uncaring—at best, indifferent. They never seem to leave me alone. I hate this room but there is no way out. Sometimes breaking things in my room makes me feel better, but only temporarily. Once in a while someone knocks gently on the door to my room, offering promises of something better. While these people are different from the people who live my room, they never seem to stick around. So I don’t get excited anymore when they knock. Whether I smile and nod or spit and bit, the end is always the same. I end up alone in my room.

This is an extremely evocative description of the inner self that develops when someone does not develop strong inner connections to others.

So, this is the gift we can give the kids and families we work with, by being reliable, trustworthy, by actively thinking about how to create these connections. We do this by mentioning we were thinking of them, by telling them when we will next see them, by giving them a token from our office, by letting them listen to our voice mail, by notes, and many other ways. And gradually they will develop a warm and loving presence to help them through difficult times- and will have less need to resort to crisis behaviors.

Sunday, February 10, 2008

Changes from Risking Connection® Training

Recently we have had the pleasure of providing a basic Risking Connection® training and then a Train-the-Trainers training at an agency that is committed to changing its treatment practices. The administration has started this change to a trauma-informed practice, and has demonstrated their commitment in many ways including attending all of the training. These methods represent a significant change for this agency, and in addition the agency is recovering from some significant problems and serious bad events in the past. At the basic Risking Connection® training, we decided that their first initiative was going to be to increase the frequency of trying to understand the adaptive function of a behavior before responding to it.

There was a three and a half month span between the original training and the Train-the-Trainers. We began the TTT by asking what changes people had observed during that time. Within three months they noticed:

There was a boy in the school who consistently went AWOL. When they stopped punishing this behavior and began to investigate it, the boy disclosed that he could not read. When he received targeted help from a staff member he trusted, the AWOL stopped.

A resident was being mean to another. Again, instead of punishing staff explored what was going on. He was finally able to share a humiliating experience he had at school.

They started a Student Advisory Board to give the students more voice.

Staff had been annoyed by a child who always hid under the tables at meals. They then noticed a pattern that he especially did this when others were loud and began fighting. They were able to offer him more reassurance at these times.

They had begun to involve the parents in investigating the meaning of their child’s behavior, and were getting a good response.

They noticed improved student-to-student relationships.

They were individualizing their approaches to the children.

Staff greeted kids returning from a runaway with "we are glad you are back and safe" instead of a lecture or description of their consequences.

Staff were tentatively beginning to discuss their vicarious traumatization reactions with each other.

In meetings more attention was being paid to the child’s history and trying to understand their behavior.

Staff were treating each other with more respect.

It is amazing and moving how profoundly our worlds can change once we begin to understand trauma and also become more self aware.

Monday, February 04, 2008

What to do about Ashley’s Gossiping?

A Residential Treatment Center we have worked with recently sent us the following inquiry:
A school staff member asked for a restorative task for Ashley. She was trying to get some more insight to what would be a good one. Ashley has had several task in the past for gossiping and passing notes and they have not seemed to help any. She wanted to know if contacting the police department and asking what constitutes an assault charge and the legal ramifications would be a good idea. She was also thinking about her past task and what she put on them. One of the task was about what gossiping does for you or makes you feel. Ashley stated that she loved the attention she got, the drama that is created, helped her to get friends, and that she loved talking to others. These behaviors have to deal with all the drama that she has been in this week. One staff member made a suggestion that Ashley should only be able to talk to staff (for like one day) and have no verbal contact with her peers unless it is for a group/activity on the structure. Another liked that idea but we both thought it may be a little on the mean side but may help. We were asked if we had any suggestions.

What would you suggest?

My colleague Steve Brown replied:
Depending on how serious the note passing and gossiping were, I’m not sure this would rise to the level of getting a restorative task at Klingberg. It might be managed in other ways such as: having other kids talk directly with her about how it feels to be gossiped about; having her stay close to adult (sit near teacher in class) so that they can prevent note passing, etc
If she were to get restorative tasks, I would focus on the adaptive function of the behavior- to get desperately need attention, feel power by creating drama, have friends. So tasks such as: Interview 2 adults about how they get attention they need without making others angry; make collage of magazine pictures showing people getting attention in positive ways; interview adults about how they make friends without doing so by gossiping about others; role play getting to know friend in "non-catty" way. For the therapist, I’d be curious about why she likes drama so much- she feels powerful when causing it? If there’s chaos around, it feels like her family. Craziness and chaos distracts her from painful feelings.

Finally, you’ll get lot farther rewarding positive opposites of gossiping rather than punishing -- when you see a shred of positive peer behavior, comment on it, praise it, high-fives etc.

I added that Steve had given them some great ideas. I would agree that this would not be most impacted by a task, and that not talking for a day would probably not accomplish anything. The girl shows considerable insight into her behavior, and I would work from that. My suggestion would be to figure out ways to help her experience the benefits she needs in less destructive ways. Examples of that would be putting her in charge of a project in which she must organize and lead peers, having her lead small groups, having her teach or assist younger kids in academics, having her take a survey of the kids on some important topic, having her write an article for a newsletter that involved talking to various kids about something such as friendship- for example, write an article interviewing kids about the best friend they ever had and what makes a good friend- then publish the article in some agency publication. Any way she can use her leadership and ability to spread information for the good will help her develop functional alternatives.

An example would be: Ashley, we are having an assembly today- can you get the word out- we know you are good at spreading information.

Also, if her gossiping hurt a particular person in some way I would ask her how she could be especially kind to that person today, give Ashley some candy to share with her, have them do a project together, have Ashley help that person with a subject if there is one that Ashley does well. etc.

One other thing I want to say is- having Ashley talk only to staff would further increase her shame, further increasing her need for this behavior. We want to look for things that can make her feel better and more worth while, thus decreasing her need to connect through gossip and hurting others.

And, we might give some thought to how often we see this same behavior in the adult staff, and times we ourselves have done it, to remind ourselves how tempting and engaging it is and how hard it is to eradicate.

Any one out there have any more ideas? Just click on "comment" and add your thoughts.