In any sort of treatment setting, time is impossible to find. In a congregate care or school setting, someone has to watch the kids. In outpatient, there are those ever present billable hours to accumulate. Therefore, bringing staff together for formal training is often very difficult. And there are many demands on what little training time we have. So I developed these short exercises to teach one concept at a time. They are designed to be used in existing meetings such as treatment teams or staff meetings. They are designed to refresh or reinforce the concepts, not to be the main training vehicle. They provide guidelines for short team discussions of the ideas that support trauma informed care.
I thought I’d share a few here and more over the coming weeks. As you can see, the format is that the Leader introduces the topic, there is an exercise with questions, and then there is a summary. Each exercise should take around 10 minutes or so.
If you use any of these exercises in your staff meetings PLEASE comment or write me to let me know how it works out.What Helps People to Change?
- Understand the many factors that promote change
- Appreciate the role of relationships in facilitating change
ExerciseAsk participants to think of something they have done (or still do) that has negative consequences that they have NOT changed. Examples would be smoking, drinking, over eating, not exercising, etc. Without asking them what the behavior is, ask what are some of the barriers to change?
Ask participants to think of something they wanted to learn and tried to learn and were UNABLE to master (such as tennis, knitting, anything that they tried but could not become good at). Ask for a couple of examples. What does that feel like? How would it affect them if someone offered to reward them for doing it? Or punish them for not doing it? What role does wanting to do it play? If they could ever imagine getting better at this skill, what would it take?Ask participants to think of a time in their lives that they did successfully make a change- lose weight, quit smoking, etc. Ask for examples. What made it possible? What started their change effort? What factors made it possible to make the change at that time? What helped? Ask about the role of other people and relationships in making the change. Ask about some examples: if you are on a diet does it help to have another person remind you of it? If you go to a restaurant and bread is placed on the table, what is helpful for your companion to do? If you mess up and over eat, what response to you want from another? Note that different people want different kinds of support. What did you feel about having made this change?
How can you relate these insights to the kids making changes?
- Rewards and consequences are not enough, they only increase/decrease motivation- also need skills and support
- What part of change is influenced by self-image, hope, feeling a different is possible?
- The role of relationships in supporting change
1. Understand how trauma undermines the concept that one can take effective action to resolve problems and achieve one’s goals
2. Identify opportunities within the program to allow the clients to practice effective actionLeader:
Traumatic and neglectful experiences are characterized by the impossibility of effective action. There is nothing the child can do to change the situation and make it better. The child gives up on the possibility of effective action. The child does not learn how to solve problems, how to assert his or her own wishes, how to make up for wrong doing, or how say no. Therefore, the child resorts to more extreme measures or gives up. When the child does something wrong he feels that all is lost and often insists on leaving the program. He has no hope.
1. What do we do that discourages or prohibits effective action?
2. What do we do that allow the child to practice effective action? (Student councils, involving the child in treatment planning, peer mediation, etc.)
3. How can we give the child practice in effective action, to heal relationships, correct mistakes, and accomplish goals?Leader:
1. Why is it important to believe that effective action is possible?
2. What would be the consequences of encouraging passivity?
3. How can a child learn to stand up for herself in positive ways?
1. Understand the human danger response
2. Understand that trauma leaves children stuck in this danger response
3. Identify strategies to help children calm down in times of dysregulation
The human brain responds instantly to danger. We do not choose to do this, it just happens, because when there is danger, we need to act quickly. We become hyper alert and focused on danger and safety. Our brain withdraws blood from non-essential activities such as digestion, and brings all the body’s resources to the muscles necessary for fighting or fleeing. Our hearts beat fast. One of the functions that is shut down is analytical thinking, because in times of danger we don’t need to think, we need to act.In the normal course of events the danger ends and the person gradually relaxes. However, when a child is repeatedly faced with unpredictable danger beyond her ability to cope she becomes stuck in the danger response, and is always somewhat activated. This results in the child being overly reactive, concentrating only on danger and safety, and being unable to relax. Both sleep and play are difficult. When new things happen, the child often over-reacts.
A sense of safety is necessary before the person is available for connection.
ExerciseAsk participants to remember a time they were in a near-car accident or otherwise faced sudden danger.
1. What happened in their bodies?
2. If they were sleepy, were they still?
3. If they were admiring the scenery, were they still looking at it? What were they now paying attention to?
4. If they were chatting with a friend, were they still doing so?
5. What happened afterwards- how did they return to normal?
6. How would it feel to be stuck in the danger response?
7. In what ways do we observe that our children have difficulty with relaxation?
What are the signals of physical and psychological danger in our treatment programs? What are the signals of safety?
How can we decrease danger and increase safety?
1. The human danger response is automatic.
2. The child experiences more danger than she can handle.
3. The child gets stuck in the danger response.
4. The child can learn to recognize this and learn ways to calm herself without help.