Sunday, April 07, 2013

Question from a New Therapist

I recently received the following inquiry (posted with permission).

Hi Patricia,

I was just reading your blog on trauma-informed treatment planning for children. I am a fairly new social worker who works part-time in the community with children who have varying degrees of trauma. I am currently working with an 8 yo female who has had multiple traumas (substance abuse, physical, emotional and possibly sexual abuse, removal from home, placement in a crime-plagued inner city neighborhood) I am at a loss as where to even start, problems are so overwhelming…hoping you could share your goals and objectives. I found the info in your blog very helpful and it has assisted me in beginning to prioritize but would appreciate any help you cold give me.


My answer was:
Hi Linda,
First of all, do you have any help? Like Supervision from your agency?
Have you taken any training or trauma?
In working with your client, my first thought would be to her current situation. Is her current foster placement safe? Have the foster parents received any training on trauma, or could they? It is important that they understand that current symptoms she may display are not because of them, but because of her history. And that she will not trust them at first and will take a long time to form a relationship with them.
Then the next priority would be any unsafe behaviors she is displaying. Explore what they are and what they do for her- what problem is she trying to solve? How do her behaviors help her? How you work with her in therapy depends on what kind of kid she is. Can she talk about herself? Would it be better to use art or other mediums? If she is not able to be verbal, use rhythmic interactions- like taking a walk, rocking, pushing a big ball back and forth between you. Over time this helps her body become calmer and more regulated.
When/if she is ready try teaching her some regulating techniques, even as simple as taking a deep breath. Have you ever heard of TF-CBT? They have a free training at I DO NOT recommend you do a trauma narrative until she is really safe and solid, which may not be within your time with her. But this training includes some good symptom management techniques.
Don't get drawn into the idea that what you are supposed to do as a therapist is to get her to tell you what happened to her. That is a much later step, one she may not be ready for for years, if ever. Your job is to help her become more regulated and safe.
Most importantly your job is to help her change her basic template about people. You do that through forming a relationship with her. Through your being trustworthy and not hurting her, she learns that some people are good. This may be the most important thing to do. But this, too, may not be easy as she will try to push you away.
There are many resources for you to learn in this area. One book that is a good starting point is Building the Bonds of Attachment by Daniel Hughes. Here are some others:
Allen, Jon. (2001). Traumatic Relationships and Serious Mental Disorders. New York: Wiley and Sons.
Blaustein, M. and Kinniburgh, K (2010) Treating Traumatic Stress in Children and Adolescents: How to Foster Resilience through Attachment, Self-Regulation, and Competency The Guilford Press
Diffenbaugh, Vanessa The Language of Flowers: A Novel Ballantine Books; (2012)
Hughes, Daniel. (1998). Building the bonds of attachment: Awakening love in deeply troubled children. Jason Aronson
Perry, Bruce and Szalavitz, Maia. The Boy Who Was Raised as a Dog: And Other Stories from a Child Psychiatrist's Notebook Child Psychiatrist's Notebook--What Traumatized Children Can Teach Us About Loss, Love, and Healing (2007) Basic Books
Saakvitne, Karen et al.(2000) Risking connection: A training curriculum for working with survivors of childhood abuse. Lutherville, MD: Sidran Press.
Saakvitne, Karen, et. al. (1996) Transforming the pain: A workbook on vicarious traumatization. New York: W.S. Norton
Saxe, Glenn; Ellis, B. Heidi; and Kaplow, Julie B. Collaborative Treatment of Traumatized Children and Teens: The Trauma Systems Therapy Approach (2006) The Guilford Press
 There is a lot of good free information in my blog. I have written recently on changing the template on 11/11 and 11/18. On 8/14 I wrote about changing the brain.
And of course there is my book, Trauma-Informed Treatment, The Restorative Approach available at
 Good luck, Linda, and let me know if I can be of further help.
 Anything else you would have added? Click on "comment" and let me know!