Sunday, October 24, 2010

The Characteristics of a Good Trauma Informed Residential Therapist

The most essential characteristic of a therapist that will succeed in a trauma informed congregate care treatment program is that he or she likes the children and their families. This probably cannot be taught. These children can be difficult, demanding, and try anyone’s patience. If the therapist does not find them delightful, cannot see their goodness, does not look forward to being with them, she will have nothing to help her get through the bad parts. The children generally feel hopeless. They do not see their own worth and cannot imagine a positive future for themselves. If the therapist cannot do that, who will? And at times the therapist holds the hope for the whole team. One role of the therapist is to see a picture of how this particular child would be if he were at his best, even while remaining aware of the child’s current reality. The therapist who genuinely cares about and appreciates the children and their families can do this.

A therapist in a congregate care setting must be flexible. The day never turns out as one expects. Things rarely go as planned. It is time for an important family meeting and the child is at the park. An individual session is scheduled but another child is threatening suicide. The therapist is going to do her paperwork and the licensing inspector drops in for an unscheduled visit. Roles shift between people. The child needs to talk with her now. A person who needs a predictable day would not be happy in this setting.

Working with a therapeutic team is a particular experience. For some, it feels wonderful to have so much help and support. For others, it is difficult to have to share everything, discuss everything and make decisions within a group. The therapist who enjoys teamwork will be the most successful in congregate care. Often the teamwork is frustrating. There are factions, problems, disagreements. The therapist tells twenty six people about something and the twenty seventh complains that she wasn’t told. Decisions are made and then not carried out. Interpersonal issues between team members can be intense. Yet the treatment team can be the most powerful intervention possible in helping a child to change. And as the therapist struggles with the pain and difficulty with the work, it can be sustaining to have a team to share with. The team can laugh together, cry together and care together about the clients. The therapist that flourishes working in this complex environment will have the ability to form relationships with other staff, will assume good intensions in fellow workers, will give and accept feedback, will handle disputes openly, and will notice and praise the positive efforts of others.

At this level of care, a therapist must be able to tolerate chaos and intensity. The symptoms that the children display are frightening and are often life-threatening. There is usually more than one child in crisis at once. The families too can be angry, demanding, sad and scary. The systems around the child are often inadequate and frustrating. The therapist must know how to stay calm herself in the face of the agitation of others. She must prioritize and respond to the problems step by step. She must also be able to tolerate strong emotions in the clients, and stay with the client as they experience their pain, longing, anger and sadness.

In order to do this the therapist must have or develop good self care skills. All therapists will experience vicarious traumatization. The therapist must use their team to help them through difficult times. Outside of work the therapist needs strong supports and connections in order to maintain a work/ life balance.

A sense of humor is crucial for surviving and thriving in these jobs. Self awareness is also essential. The therapist needs to notice her responses to individual children and families, and use these responses to deepen her work. She should accept seek out and accept help in this area from her supervisor and her team. She should monitor her vicarious traumatization and know when she needs a break.

There are many skills and much knowledge that a therapist should have, but these can be taught in supervision or through workshops and training. If the therapist is eager to learn and grow, the agency must only provide the opportunity. In addition, the therapist must know or learn writing skills and have the ability to document and do treatment planning. Of course, the therapist must be responsible, come in on time, and be self motivated in completing her job requirements. Often, some on call duties will be part of the job.

It would be wonderful if agencies had the ability to pay this paragon what she is worth!

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