Sunday, September 25, 2011

Michael Trout at the ATTACh Conference

I have just returned from a wonderful week immersed in learning about new treatment ideas and meeting marvelous people. I have a lot to share. This week I am going to focus on Michael Trout, who I had the honor of meeting at the ATTTACh conference ( Michael is the author of the Multiple Transitions video that we include in our Risking Connection training. This video, which our participants always find so moving, can be purchased at the Infant Parent Institute store ( Many organizations have begun to use it to train new staff, and I highly recommend it.

Michael Trout is the Director of the Infant Parent Institute which engages in research, clinical practice and clinical training related to problems of attachment. He was the founding president of the International Association for Infant Mental Health; was on the charter Editorial Board of the Infant Mental Health Journal; served as regional vice-president for the United States for the World Association for Infant Mental Health; and currently serves on the board of directors (and as editor of the newsletter) for APPPAH — the Association for Pre- & Perinatal Psychology and Health. In 1984 he won the Selma Fraiberg Award for “ . . . significant contributions to the needs of infants and their families.” Mr. Trout has produced 14 clinical training videos that are used by universities and clinics around the world, including the six-hour video training series, The Awakening and Growth of the Human: Studies in Infant Mental Health. He has also written and produced four videos focusing on the unique perspective of babies on divorce, adoption, loss and domestic violence. The most important part of Mr. Trout’s work continues to be in his quiet private practice where he sees individuals and families of all ages on a daily basis.

I attended a work shop by Mr. Trout on the topic of the therapist as a secure base for their clients. He showed videos and led the audience in an experiential exercise to demonstrate attunement. Mr. Trout shared three actions that are essential for the therapist to create a secure base.

Wonder: The therapist must approach the patient with genuine curiosity and awe. He must remain interested in this person’s story, this person’s experience. This wonder can be side tracked by theories. If the therapist thinks he already has the situation figured out, his mind will only go down one path and he will close his eyes to contrary evidence. Hearing others describe the patient, or reading their record, can also interfere with wonder. Hurrying, or having a pre determined agenda, are also problems. When the therapist keeps his mind open in wonder and curiosity, he will deeply hear the patient, and that person will know they have truly been seen.

Following: The therapist must be in pursuit of the patient. The therapist does not come in with a pre-decided agenda. He follows where the client wants to go and what the client wants to talk about.

Holding: This takes many forms. Its opposite is dropping. It means creating a feeling for the client that the therapist has his back. You won’t starve, I won’t leave, we will work this out together. It may require active advocating for the client.

These are the elements of creating a secure bases for the client.

Mr. Trout ended his workshop with a meditation from a CD that can also be purchased at the Infant-Patent Institute store. I plan to add it to my training. It comes from this CD (I include the description from their web site).

The Hope-Filled Parent

What could meditation mean to a foster mother who has learned to arise at 5:15 each day, in order to have 10 minutes of quiet before she begins the careful morning ritual needed for awakening her deeply troubled child without a meltdown? What could meditation mean to an adoptive father sitting alone at midnight, pondering what was happening to the peace of his home, the safety of his other children, and the intimacy he used to share with his wife? Could meditation make a difference to those foster or adoptive families who are on the brink of placement disruption, who are about to conclude they can simply not make it through another day?

Use these meditations in any way that suits you. There is no right or wrong way. If you find one that particularly speaks to you, you may find yourself listening to it every day, at about the same time. Maybe you will invite your spouse to join you, on the screened-in porch. Maybe you will listen to the entire CD on certain nights of despair, or listen to a funny one in the kitchen, while whistling. But it is my hope that you will find something herein that restores hope, that challenges your feelings of impotence that reminds you why your efforts are far from being in vain.

Sunday, September 18, 2011

A Week of Travels

I am leaving today for a week of travels. I will go first to Detroit, where I will present at the 2011 National Health Care for the Homeless Regional Training. I will be speaking about Vicarious Traumatization. I also look forward to attending the conference, and hearing a presentation about Trauma-Informed Care by Scott Petersen, LCSW, and CADC; Laurie Hardin, MSSW.

On Tuesday I will travel on to Omaha, Nebraska, where I will attend the ATTACh Annual Conference, Attachment and Trauma Through the Eyes of a Child. I will have the opportunity to hear Edward Tronick, PhD speak about Peek-a-boo, Culture and Social Development: How Infant Meaning-Making Processes Are a Central Mechanism in Governing both Typical and Pathological Child Outcomes. I have heard Dr. Tronick at the Boston trauma conference, and I always learn a lot from him. I am also looking forward to hearing my dear friend and author of Risking Connection (among many other achievements and books) Laurie Anne Pearlman, PhD, Laurie will speak about Vicarious and Secondary Trauma: The Costs of Caring. I am also planning to learn about Integrative Treatment for Complex Trauma in Adolescents (ITCT-A) from John Briere, PhD. Karen Buckwalter, LCSW & Michael Trout, MA are presenting The Therapist as a Secure Base. It will be interesting to meet Michael Trout and tell him how much his video Multiple Transitions has meant to our Risking Connection learners.

There are also many other great leaders in our field at this conference. I will be discussing The Restorative Approach on Friday afternoon. I also look forward to seeing my friends from CALO. CALO is a sponsor of the conference.

If you are attending either of these conferences, please come up and say hello. I would love to meet you.

Sunday, September 11, 2011

Trauma Informed Care and Homeless Services

Since to day is that last day of my vacation, I thought instead of writing a new post I would share this artcile from SAMSHA. It is about trauma informed services for the homeless, but is applicable to all services.

Trauma-Informed Care 101

Author(s): Guarino, Kathleen

Description: How can providers help care for people who have experienced trauma? People who are experiencing traumatic stress do not relate to the world in the same way as others. They require special care. In this article, the HRC shares best practices for trauma-informed care. These include understanding trauma and its effects, creating safe physical and emotional space, supporting consumer choice and control, and integrating trauma-informed care across service systems.

Some people experience very few traumatic events in their lives. For others, experiences of traumatic stress are chronic. Research and experience tell us that for people experiencing homelessness, rates of trauma are extraordinarily high. Many who enter the homeless service system have experienced violence, loss, and disruptions to important relationships from an early age.
Additionally, people who are homeless experience the loss of place, safety, stability, and community. These losses are also traumatic. They have a major impact on how people understand themselves, the world, and others. People who have experienced multiple traumas do not relate to the world in the same way as those who have not. They require services and responses that are uniquely sensitive to their needs.

What makes an experience traumatic?

•The experience involves a threat to one’s physical or emotional well-being.
•It is overwhelming.
•It results in intense feelings of fear and lack of control.
•It leaves people feeling helpless.
•It changes the way a person understands themselves, the world and others.

Becoming Trauma-Informed

We know people can and do recover from trauma, and we want to provide services and environments that support healing. To be a “trauma-informed” provider is to root your care in an understanding of the impact of trauma and the specific needs of trauma survivors. We want to avoid causing additional harm to those we serve.

What does this mean in practical terms? How is this different than business as usual? Here are some concrete practices of trauma-informed care.

Understanding Trauma and its Impact

Educating providers on traumatic stress and its impact is essential. Trauma survivors, particularly those who have experienced multiple traumas, have developed a set of survival skills that helped them to manage past trauma. These survival strategies (like substance abuse, withdrawal, aggression, self-harm, etc.) make sense given what people have experienced. But they can be confusing and frustrating to others and often get in the way of current goals.

Without an understanding of trauma, providers may view those they serve in negative ways. Providers might describe behaviors as “manipulative,” “oppositional,” or “lazy.” Yet these behaviors may be better understood as strategies to manage overwhelming feelings and situations. Trauma-informed training can help providers understand these responses and offer trauma-sensitive care.

Promoting Physical and Emotional Safety

Traumatic experiences often leave people feeling unsafe and distrustful of others. Creating a sense of physical and emotional safety is an essential first step to building effective helping relationships.

Safe physical environments may include:

•Well-lit spaces
•Security systems
•The ability for consumers to lock doors
•Visible posting of consumer rights
•Culturally familiar decorations
•Child-friendly spaces

Practices that help to create a safe emotional environment include:

•Providing consistent, predictable, and respectful responses to consumers across an agency
•Asking consumers what does and does not work for them
•Being clear about how consumer information is used
•Providing opportunities for consumers to engage in their own cultural and spiritual rituals

Supporting Consumer Control and Choice Situations that leave people feeling helpless, fearful, or out of control remind them of their past traumatic experiences and leave them feeling re-traumatized. Ways to help consumers regain a sense of control over their daily lives include:

•Keeping consumers well informed about all aspects of their care
•Providing opportunities for consumers to give input into decisions about how a program is run
•Allowing for consumer control over their own spaces and physical belongings
•Having clear boundaries around and giving advanced notice for room or apartment checks
•Ensuring that consumers have input into their service goals
•Using interventions respectful of and specific to cultural backgrounds
•Maintaining an overall awareness of and respect for basic human rights and freedoms regardless of housing status.

Integrating Care Across Service Systems

Becoming trauma-informed means adopting a holistic view of care and recognizing the connections between housing, employment, mental and physical health, substance abuse, and trauma histories. Providing trauma-informed care means working with community partners in housing, education, child welfare, early intervention, and mental health. Partnerships enhance communication among providers, and help minimize consumers’ experiences of conflicting goals and requirements, duplicated efforts, and or of feeling overwhelmed by systems of care. It helps build relationships and resources to provide the best quality of care possible.

Becoming trauma-informed means a transformation in the way that providers meet the needs of those they serve. The ideas above are only a beginning. Change happens as organizations and providers take these ideas, as well as their own, and use them to evaluate and adapt their approaches to care.

Sunday, September 04, 2011

Hiring for Trauma Informed Care and a Prize

Agencies have discovered ways to determine whether a candidate is comfortable working in a relationship-based approach.  In some cases agencies have developed a statement that describes their treatment approach and asked candidates to read and decide if they can work that way, and return it signed if they want to proceed with the hiring process. It is useful to ask candidates how they deal with stress and what self care practices they find helpful. Another way is through the use of scenarios.Other options include:
  • Ask a candidate about a time when he or she was successful in making a change and what helped him or her
  • Ask a candidate with prior work experience to describe a client that they felt especially connected to, and one they found it difficult to connect with, and why. This question looks for self awareness of differing response to different clients
  • Ask a candidate about a time when someone helped him or her, a teacher or a mentor or anyone significant in their life. What did that person do that was helpful?
  • Ask what do you think might be the most difficult time of day for clients
  • Ask what can staff do to make clients feel safer/ more comfortable around bedtime and/or shower
Offering the candidate an opportunity to observe in the milieu can clarify both for the candidate and for the employer whether or not there is a fit.

What have you discovered that is helpful? Press comment and enter questions and scenarios you use. I will offer a free copy of my book "A Child's View of Trauma" to one of the entries that includes their email (so I can contact you). This book is for clinicians to teach kids about trauma. Please join in- I will share the ideas in this blog. Click COMMENT.