My Book is Available!

Order from www.nearipress.org. Choose bookstore and then put my name, Wilcox, in the search engine.

I am so delighted to report that my book came out this week. It is entitled: Trauma-Informed Care: The Restorative Approach. This book is a practical guide to implementing trauma-informed care in all sorts of settings. The focus is on making our every day actions in treatment settings match what we know from brain science helps children heal.

Chapter One introduces the trauma framework, a useful road map to understanding both the effects of trauma and how people can heal. Although we have considerable new information about what helps people heal from trauma, many programs serving the children who have experienced the most trauma have not yet incorporated this information into their treatment or their programs’ milieus.

In the following chapters I provide a specific treatment design using this new brain science as the blueprint for treatment programs for children. Chapter Two is an overview of the method, including its theoretical underpinnings, day-to-day operations, how it addresses shame, and answers to common questions and concerns.

Chapters Three, Four, and Five use case examples to convey the specifics of the approach. Chapter Three focuses on demonstrating the daily workings of a trauma-informed treatment program. Chapter Four illustrates the power of how staff define and talk about the children and their behaviors. Chapter Five contains examples of the challenges of caring for traumatized children, and how the method works during hard times.

Chapter Six examines one of the most difficult decisions in implementing trauma-informed care: how to respond when the children hurt others. This chapter asks providers to consider their theory of change, and to operate from a theory of what will actually help the child be less likely to repeat this behavior. It introduces the restorative task, a response that incorporates opportunities for healing and for making amends, and gives examples of such tasks. Suggestions for improving tasks and how to respond if the child refuses the task are included.

Chapter Seven focuses on the role of the clinician in trauma-informed care, the characteristics of a clinician who will succeed in this system, and necessary training. In the Restorative Approach, the clinician and the child-care team work closely together providing individual, group and family therapy as essential parts of the treatment program. Treatment planning reflects the therapist’s theories of what steps help a child heal. As in all best-practice programs, the therapist will need support and supervision in order to lead the team in a clinical approach to behavior.

Chapter Eight covers the importance of providing trauma-informed care for the families. Most of the parents of children in treatment are themselves trauma survivors, which presents unique challenges in parenting. The program helps them by being attentive to their need to feel safe and to build trust. A key component is to recognize and honor their strengths, and to provide opportunities for the family to have fun and joy together. The families can be educated in the restorative approach and experiment with using it themselves when the client is at home.

Chapter Nine extends the restorative approach to foster care, describing how training in understanding trauma can help foster parents not to take behaviors personally and to keep the child despite behavioral problems. Formal training is important, and the support workers use of the theory to understand actual events will solidify the family’s understanding.

Chapter Ten looks at characteristics of the agency-as-a-whole that support trauma-informed care. The role of agency leadership is crucial in implementing this approach. The agency structure makes a big difference in the success of the Restorative Approach. Developing the necessary culture of connection takes time, but enables the approach to endure. The physical plant affects the experiences of both the clients and the staff.

Chapter Eleven, “Cultivating a Trauma-Sensitive Staff,” describes the processes that are essential to develop and maintain a good staff. Many agencies find that staff turnover decreases after the implementation of trauma-informed care. Hiring, training, supervision and promotion are all crucial tools. Certain skills that support a trauma-informed approach can be deliberately taught. Most crucial is attention to vicarious traumatization, the way the work affects staff and how they can take care of themselves and each other to stay alive and hopeful in the work.

Chapter Twelve covers the actual change process, and what steps an agency can take to facilitate the change. A transformation committee is a good mechanism to lead the change. Later steps include changing policies and procedures to solidify the changes. John Kotter’s Stages of Change (1996) form a helpful guide to examine the process.

Chapter Thirteen concentrates on sustaining the change. Unfortunately there are many forces pushing the system back towards a punitive approach. Certain challenges can be predicted and addressed.

Chapter Fourteen emphasizes measuring and celebrating progress. The chapter presents various factors to measure and scales to utilize in measuring them. Results garnered from these data can be shared with funders, the Board of Directors, consumers and other stakeholders. Celebrating success will help sustain the transformation.

The Appendices contain useful tools for agencies to employ.

The books can be ordered from www.nearipress.org. Choose bookstore and then put my name, Wilcox, in the search engine.

If you do read the book, PLEASE email me (patw@klingberg.org ) and let me know what you think of it. I hope you will find it to be a valuable resource to you in implementing and sustaining trauma-informed care.

Two Conference Presentations Next Week

I am presenting at two national conferences next week. If you are attending either, please come up and introduce yourself. I would love to meet you!

The first is the annual NASW conference, Restoring Hope. The conference is in Washington, DC at the Wardman Park Marriott Hotel. My workshop is:

Using the New Brain Science to Create Hope and Healing for Child Survivors of Trauma
Date: Tuesday, July 24
Time: 3:15 pm - 4:15 pm
Room : Wilson B

The second presentation is at the Foster Family Treatment Association 26^th Annual Conference on Treatment Foster Care. The conference will be held July 22-25, in Atlanta, GA. at the Sheraton,Atlanta hotel.

My workshop there is:

Workshop D17 - Using a Trauma Framework to Strengthen Foster Placements.
Wednesday, July 25th
10:30 a.m. - 12:00 p.m.

Seriously I would love to meet you if you will be attending either of these conferences. Please say hello!

Supporting Kinship Care Foster Placements

I have recently become interested in the process of supporting relative foster parents and helping the placements to endure.

In the REPORT TO THE CONGRESS ON KINSHIP FOSTER CARE U.S. Department of Health and Human Services, completed by the Administration on Children, Youth and Families Children’s Bureau, it is stated  that “Because States' data are scarce, it is difficult to estimate how fast public kinship care has increased-but available evidence suggests that it increased substantially during the late 1980s and early 1990s. In the 25 States that do have data, the proportion of children in public kinship care increased from 18 to 31 percent between 1986 and 1990."

I was struck when a foster care leader in our state system described relative foster parents as “the most under-resourced families in the system.” It seems as though there is an un-examined assumption that because relative foster parents are well, relatives, love will carry the day and they will not need help. Foster parenting is a hard job for anyone who does it. And there are some aspects of kinship care that make it uniquely difficult.

Ambiguity of choice presents a significant stressor. Unrelated foster parents choose to be foster parents, decide that this is a good time in their lives, and have to go through an elaborate screening before even hearing the name of a child. Relative foster parents are presented with a child who is a member of their family and who is in distress. They may or may not know this child, and this may or may not be a good time in their lives. But they have to choose between taking the child or having the child go into the child welfare system. Even those who feel deeply that this is more than they can handle also feel a moral obligation to care for the child. The Report to Congress further states that: “Unlike non-kin foster parents, kinship caregivers usually receive little, if any, advance preparation for their role. In all States, non-kin foster parents are required to complete a rigorous training program before the State will license them. Such training helps future foster parents understand the needs of abused or neglected children and emphasizes strategies for meeting these needs effectively. Non-kin foster parents also have time to prepare mentally for their new roles and to adjust their living space to make it appropriate for children of a particular age. In sharp contrast, kinship caregivers often become involved in a crisis situation with little or no notice.”

Accompanying family history and dynamics are always present in the placement. The related child comes with an entire history and many attached feelings. This aspect of relative foster care seems to be rarely discussed in the literature, but is a powerful factor in the outcome of the placement. For example, if a grandmother is caring for a grandchild, that child inevitably connects to a history of pain and distress with this mother’s own child. Perhaps the child’s mother is addicted to drugs. Inevitably her mother, the child’s grandmother, has suffered a lot of pain around this. She may have taken her daughter to treatment progress without success. She has often been deeply hurt by her daughter’s betrayal, such as if her daughter has stolen from her. She has experienced many episodes of hope when her daughter was in rehab or appeared to be turning her life around, followed by despair when the drugs took control again. Furthermore, she may have had experiences with the child’s father, perhaps bad ones. Maybe the child’s father was abusive to her daughter. All of this hurts a mother’s heart and leaves deep impressions. And in fact her daughter is often still in the area, drifting in and out of the family’s life.

How does this all effect the grandmother’s relationship with the child? She loves the child. She wants to do the best for him and raise him right. She wants to protect him from all harm. Yet who does the child look like? How hopeful does she feel towards the child’s future? How resentful does she feel about having this added responsibility in her life at this time?

All these factors are also influenced by the relative caregiver’s health, his/her financial and social situation, and many other aspects of their life.

Often the caregiver has no one to talk to about this, no one to validate their complex feelings and to help them separate the present with the child from the past with the child’s parents. So, the child and the caregiver are both being profoundly influenced by the unexamined past.

Then,  to continue to quote the report, “Unlike trained non-kin foster parents, kinship caregivers often receive little formal training and may have a limited understanding of the child welfare system, what is expected of them, and the resources available to assist them. Kinship caregivers, however, generally have greater knowledge of the family history and dynamics that have created the need for a child to be placed outside the home. Not only are public kinship caregivers less likely than non-kin foster parents to receive services, their needs are more often overlooked. Public kinship caregivers are referred for, offered, and actually receive fewer services for themselves and for the children in their care public kinship caregivers are less likely to request or receive educational or mental health assessments, individual or group counseling, or tutoring for the children in their care.”

Specifically, the kinship care providers often receive little training about trauma, how it affects children, and how they can heal. The main advantage of having such knowledge is that it enables parents to define the child’s behavior differently. When the child won’t eat with them, or refuses to talk, or questions their directives, or has a meltdown in a store, or is aggressive with other children in the home, or won’t go to sleep at night, the parent sees this as rejection, defiance, and a behavior to be eliminated. If the parent is given training that really helps them understand behavior differently, they instead can define the behavior as fear, emotional over load, and problems with trust. This change of definition leads to a complete change of reaction. The kinship care parent is less likely to take the behavior personally, less likely to respond with punishment and more likely to respond with support. This training is essential for kinship care parents. And it must be available in many flexible delivery modes, including a trained person who can offer the parent training in their home individually. Support groups can be both helpful and powerful, but for some parents the thought of having to schedule attendance at a group is such a stressor that any benefit is undermined. A flexible delivery system allows each parent to utilize the help that fits where they are at the moment.

Another essential component of supporting kinship care is to pay attention to the experience of the parent themselves. How is being a kinship caregiver affecting the parent themselves? At a recent training one foster mother stated that she had been a foster mother for sixteen years and no one had ever asked her how the work was affecting her. Caring for children with trauma histories produces vicarious traumatization in foster and kinship care parents as it does in treatment workers. Foster and kinship parents have the additional stress of being largely alone when crisis occur; of possible getting pressure from extended family; of losing friends and family because of being unable to leave the child; of worrying about the effect of the foster child on their biological children; and other issues. For kinship foster parents managing the relationship with the child’s biological parents may be another source of stress.

The kinship care parents need a safe place to discuss all this and to receive validation. This can be individual or in a group. A group, when it is possible for a parent, has the strong benefit of helping the parent that they are not alone. But the parent needs to be educated on the inevitability of vicarious traumatization, how to care for oneself to combat it, and how to maximize the transformative power of providing foster care.

The limited information we have about relative foster care does show that despite the lack of education and support services, relative placements tend to last longer than non-relative placements. We desperately need to create stability for these children that have been hurt through no fault of their own. All the other healing they need and deserve can only take place when they feel safe, cared for and that they belong somewhere. It seems that one way that we could increase that safety would be to provide more and earlier support for kinship care families.

What are your thoughts on this? Have you done any work in this area? Do you know of anything written about supporting kinship care families? Please click on “comment” and let me know. Thank you.

The Real World, Once More

I did a consultation for a treatment team this week. They were a delight to work with. They are very used to looking for the need behind behaviors, and are caring and sympathetic to the youth in their care. Still, they struggled with the same issues everyone else does.

Validating does not mean agreeing.

Tenesha said: “I think this validating can backfire. I mean, When Stacey says she hates this place and everything we do here sucks and the staff are unfair, how can I tell her that she is right? I don’t agree and it would be going against my self and my team.” This reflects a misunderstanding of what validating is. Tenesha does not have to tell Stacey that she agrees with her- she doesn’t. Instead, validating is saying that she hears what Stacey is saying and understands what she is feeling. So, Tenesha does NOT say, “I know, Stacey, this is a lousy place.” Instead she says: “Right now you hate living here, and everything about the place is on your last nerve.” To say this with genuine feeling, Tenesha thinks about how hard it must be to be fifteen and have no family, and to be the only girl in your high school who does not live at home. Then she asks Stacey what in particular is bothering her right now, and tries to help her solve whatever her problem is.

Living in the Real World

Then in the consult Maria said “I still think this validating can go bad. I mean, we validate, validate, validate. What are these kids going to do when they get out in the real world and no one validates them?”

First of all, I think it is interesting that when people make these comments they always portray the real world as so harsh. I live in the real world, and I receive quite a bit of validation- luckily.

Getting What You Want Makes You More Able to Do Without It

But anyway. I would like to talk about the fact that meeting a child’s needs makes them MORE likely to be able to meet the next challenge, not less. When ever teams consider doing something special for a child (sit at her door at night, give him special food, allow him to stay up late) they become concerned that the child will want them to do this forever. Yet, when we feed a baby milk on demand we are not concerned he will want milk forever. We help a toddler learn to walk and to deal with obstacles in full confidence that he will be more independent in a few months.

To further understand this, let’s meet Jose and Richard. They are in fifth grade together, and they both love action figures. Jose has quite a collection, and he brings some to school and the boys stage elaborate battles and adventures. Occasionally, Jose invites Richard over to his house after school. This is very exciting for both boys, because Jose has lots of action figures and their accessories. Now they can really create some stories. However this doesn’t happen too often, because Richard cannot ask Jose to his house, and he feels bad going to Jose’s too often. Richard never knows what his mother will be like in the afternoons, and whether he will have to take care of her. Besides, he shares his room with his brothers, and he only has four action figures and one accessory. He’d be ashamed to have Jose over.

As the boys grow older, which boy do you think most easily got bored with action figures and started to become interested in teenage things? Which boy said to a teacher that he trusted: How am I supposed to start growing up? I haven’t had enough time to play with my action figures!

To belabor the obvious a bit- Jose’s father did not say: “Let’s not give Jose any action figures, because then when he grows up he will always want to play with them.” When you get what you need at the moment, at the right stage of development for you, you take it in, and then you move on when your needs have been met and you are excited by the next phase. If you do not get what you need, your needs are not met, you stay at least partially stuck in that stage, and moving on is more difficult.

So, our kids have never been validated. Nothing in their lives has indicated that anyone was putting their needs first: not when they were neglected, not when they were abused, not when they were moved, and moved again, and again. They have a huge developmental hole where validation should have been. In other words, they have had few experiences in which someone said, I get it, I understand what you are feeling, I see how you could be feeling that way, and maybe even: I have felt that way myself. They have had few experiences of feeling: I am not alone.

So validate all you can- it won’t turn against you. And then when the youth leaves, maybe she will seek out more validating people, because now she knows how good that feels. And if she runs into non-validating people as we all do, she will have inside her a memory of how you understood her, you were on her side, and she will be able to manage that invalidation without disastrous reactions.

And you will have helped her find a life worth living!

Risking Connection throughout Connecticut

I had a delightful experience this past week. I attended a Focus Group called together through the Connecticut CONCEPT grant. This is a federal grant that Connecticut has received to make the system of care more trauma-informed. This focus group was to question providers about their thoughts on the ways in which the system of care was trauma-informed, and how it could be improved.

The Focus Group consisted of about 15 providers, among whom I only knew a couple.

What was so moving is that when the questioner asked questions around agency practices that were trauma informed, almost all the agencies started talking about Risking Connectionâ. The providers spoke of using Risking Connectionâ as their main staff training vehicle, and requiring it for all staff. They described how RC had changed the way they operate with regard to clients. They spoke so enthusiastically about how important their participation is to them.

Another thing that was important to me was that when the questioner asked about attention paid to vicarious trauma, the providers again spoke of Risking Connectionâ. They credited RC for having brought their attention to these phenomena. They described many interventions their agencies had instituted to pay attention to VT and to make space for workers to discuss how the work was affecting them.

People also mentioned that having their trainers participate in our ongoing training and consult groups was important.

I didn’t expect any of this when I went to the Focus Group. It was so refreshing to hear how strong the influence of Risking Connectionâ is within Connecticut.

When a Treatment Program Becomes a War Zone

I have written before about the development of a siege mentality in treatment programs (10/06/15). In that blog I described trauma-based thinking and its effects on both the clients and the staff. I also wrote a blog post on 9/11/10 entitled When Chaos Breaks Out in which I examined how to address a program that is in trouble. I would like to revisit these issues in a systematic way here.

In this post I would like to specifically address the situation in which a program has become demoralized and overwhelmed, and is just trying to make it through the night. Programs in this state rely excessively on the use of force, restraint or intervention teams. Structure and programming are lost. The staff are in a state of fear, and just move from one crisis to another. The staff are often responding to their fear of what could happen if this situation got worse, not what is happening at the moment. The clients are not feeling safe, and thus are acting more aggressive.  For both the staff and the kids there is a sense of imminent catastrophe.

How Do Good Programs Become War Zones?

There are many factors that can contribute to the development of a battle mentality in a program. The process is cyclic and can start with any combination of these factors.

·         Influx of a new, more difficult population

·         A new type of client for this agency without enough specific training

·         Significant staff turnover, in child care staff, therapists and/or leadership.

·         Not enough training for new staff

·         Understaffing and resultant over working of staff

·         Change in available resources.

·         Implementation of a new treatment approach.

·         Lack of integration of therapists into treatment program

·         Changes in regulations governing care, such as limits on the use of restraint and seclusion

·         Serious incidents of staff assaults

Signs that a Program has Moved Towards a War Zone Culture

·         Staff injuries increase.

·         Child injuries increase.

·         Lack of structure, few activities planned or carried out

·         Inconsistent application of limits

·         Increasing numbers of power struggles leading to restraints

·         Over-reliance on control.

·         Over use of calls for assistance, relying on a paging system the clients can hear

·         Living areas look bad, damage is not repaired, areas are not clean

·         Treatment plans are not communicated or followed through

·         Staff do not feel they are part of the treatment. They do not see the connection between their work and the child’s goals

·         Therapists are staying in their offices and not interacting with child care workers or hanging out in program spaces

·         High turn over

·         Supervision does not take place

·         Individual therapy does not reliably take place as therapist is handling emergencies

·         Routines are not followed

·         Use of sick leave increases

·         People speak of the clients in hopeless, blaming terms

·         Splits occur and deepen between parts of the team, and staff blame each other and administration for the problems that are occurring. There is an “us vs. them” mentality.

·         Staff reduce interactions with clients, stay in the office more, start texting their friends during work.

·         People are not sure how to intervene when problems begin (because they know they are trying not to use restraints or rely heavily on consequences) so they do nothing and feel helpless as they watch a client becomes more and more escalated.

How Can the Program Regain Its Treatment Focus?

When an agency becomes aware that one (or more than one) of its programs has deteriorated towards a war zone operation, there are roles for each group pf people that the program may want to start immediately. Follow through mechanisms should be established to track implementation. Data about restraints, staff and child injuries, hospitalizations, arrests and negative discharges can provide reliable information to evaluate the impact of interventions.

Senior Leadership

·         Begin the conversation- start talking about what is going on and the reasons for it.

·         Convey hope in the possibility of turn around

·         Establish contact with every staff member who is hurt.

·         Speak warmly and hopefully of the youth.

·         Recognize staff achievement.

·         Remind staff about their reason for doing this work, the mission, the importance to the youth.

·         Make resources available for change effort.

·         Articulate over all program expectations, such as what is meant by imminent danger and when restraint can and cannot be used, or when to call the police.

·         Congratulate team members on their stamina in sticking with a certain child, reminding them that it is the most important thing they can do.

Mid-level Leadership

·         Lead change effort

·         Establish clear expectations and methods to measure them, and regular review periods to evaluate progress, including who will be responsible. Be careful not to let sympathy for the difficult time staff is experiencing result in a relaxation of the expectations. If there are reasons the expectation was not met, how will be overcome those reasons during the next time period?  If the administration just accepts the reasons and communicates: “oh well I guess there is nothing we can do” they are replicating the paralysis felt by staff and thus increasing it.

·         The following table illustrates some areas in which expectations can be clear and monitoring mechanisms established. This is not an exhaustive list, it is just meant to illustrate the kind of clarity that is important.

Child Care Staff Expectations	Person Responsible for Implementation	Monitoring Mechanism
There will be two planned activities per weekday and three per weekend/vacation day.	Unit Supervisor	Schedules passed in, comments written on each activity, spot checks
Each child care staff member will have a chore towards the cleanliness of the unit and will complete it on each shift they work.	Unit Supervisor	Chore list passed in, spot checks
Each child care worker will be assigned three youth as their special responsibility. They will spend at least ½ hr. individual time with each of these youth per week.	Unit Supervisor	Progress notes
Therapist Expectations	Person Responsible for Implementation	Monitoring Mechanism
Therapists will attend staff meeting weekly	Clinical supervisor	Meeting attendance sign in
Therapists will make sure that the child care staff understand the children’s goals and how that is translated into what the child care worker does	Clinical supervisor	Therapist and staff report
When a child is in crisis therapist will connect with child and staff within 4 hours or will designate someone to do so	Clinical supervisor	Observation, progress notes

Further interventions for middle management:

·         Added resources in a targeted way. For example, have a cleaning service do a thorough cleaning of a unit as soon as the staff and kids have created a cleaning schedule to maintain the cleanliness.

·         Articulate and model the expected method of interacting with the kids- be involved, caring, flexible, respectful.

·         Clinical management can be clear with therapists, from the hiring onwards, that they are expected to be part of the team and not doing outpatient therapy in their office. Teach and give examples of how to translate treatment goals into unit activities for staff.

·         Clinical management guide and model for therapists how to lead team in clinical thinking. The therapists and clinical management establish clinical thinking by responding to every attempt to discuss a problem behavior by asking: how do we understand this behavior? When we understand the adaptive nature of the behavior we can respond by helping the child to learn to meet these same needs in a more positive way. The clinicians also make sure to share the formulation with the team, to establish a treatment theme, to connect problem behaviors to past history, and to suggest restorative responses based on the team’s understanding of the skills a child needs to learn.

The Child Care Workers and the Therapists

It is counter-intuitive but the essential that when a unit is in crisis, the staff must move towards the youth, not away from them. The natural human response to harmful behavior is to move away. This can manifest by emotional distance, by increased strictness, by lack of activities, by staff spending more time in the office, or simply by frowns and disapproving looks. By their behavior the youth are telling the adults that they do not feel safe or connected. We have to make plans to increase their connection to adults. How do we do this?

·         Schedule time for staff to spend with one-to-three clients, doing a pleasurable activity.

·         Organize team building activities, using consultation from recreational therapists if available.

·         Have as many fun activities as possible.

·         Use music, dance, singing, jump rope rhymes, hand games to knit the community together.

·         Develop a cottage song, a mascot, a logo, a saying.

·         Celebrate anything good that happens, even if small.

·         Have a box in which anyone can put a note about a good thing they saw a kid or a staff do, read it out at community meetings. Give awards, but not competitive ones, ones that anyone who meets some criteria can receive.

·         Have community meetings. Have all participate. Talk about what is happening, what kind of place we want to live, what we can do about it.

·         Decrease room time. Spend as much time together, doing activities.

·         Do the kids’ hair. Have a spa night. Feed them. Do anything to care for them and make them feel better.

·         Clean and decorate the unit. Involve the kids.

·         Fix any damage. Involve the kids.

·         In Treatment Team talk about the kids that are the hardest to connect with. Review their history- why did they have to learn to put up such walls? Encourage compassion. Discuss their strengths and interests. Can staff find a way to participate in these interests with them?

·         Keep a notebook about the most difficult kids called “Moments of Hope” and ask staff to write down any good things that happen with that child.

·         Congratulate each other on the team’s stamina in sticking with this child.

·         Make specific plans to support that stamina, like trading off who reaches out to the most hostile kids.

·         Remind each other about other kids you have known who seemed to reject all efforts and later came around.

·         In treatment team develop restorative ideas for each child that are significant, require thought, and are related to their treatment.

·         Teach specific feelings management skills.

·          Use feelings management skills yourself and label out loud that you are doing so.

·         Validate the feelings behind the behavior.

·         Express an understanding that this is the best the kid knows at the time- and the hope and confidence they will learn better.

·         And tell them, and show them, over and over again, all the good things you see in them and how delighted you are by everything positive (and even neutral) that happens.

Even this partial list of interventions seems like a daunting task. It is. What is more daunting is not doing it and remaining in paralysis. A specific plan with clear responsibilities and methods of measurement will begin to create change. As people notice change, there will be an increase in hope. Hope brings the energy to make more changes. And fairly soon people will be feeling pride in their workplace again, and the kids will be gradually getting better…slowly…with many backslides…but they will be demonstrating that they feel more connected and relaxed. Then real effect treatment will be occurring.

Building Hope

Last week I attended and presented at the MASOC/ Massachusetts Association for the Treatment of Sexual Abusers 14th Annual Conference on The Assessment, Treatment and Safe Management of Sexually Abusing Children, Adolescents and Adults. I particularly enjoyed being part of a gathering of NEARI Press authors, and celebrating my soon-to-be-released book. It is in the NEARI press catalog and is expected to come out in June. Steve Brown also presented, his workshop was entitled: “I Can’t Get that Picture Out of My Head” – Vicarious Trauma in Work with Sexual Abusers – What It Is and What We (and Our Agencies) Can Do About It? My presentation was entitled: How to Use the New Brain Science to Provide More Effective Treatment- and to Have More Fun at Work. I guess you are doing okay as a presenter when the only improvement suggestions you get are to make the presentation longer. I was very moved when later in the day a woman I did not know came up to me and said: “that was the most helpful presentation I have ever been to”. If you are reading this in CT, I will be presenting on the same subject at the NASW Annual conference this Friday.

I attended a workshop entitled Parenting with Love and Limits (PLL): A Promising Practice for Sexually Aggressive Youth by Paul Castaldi, MSW. The presenter referred to a meta-analysis of the amount of improvement in treatment (I did not get the citation). He stated that the one variable that consistently correlates with improvement is the creation of hope.

So this made me start thinking: how do we actually create or enhance hope? Many of our clients have good reason to feel hopeless. We serve children who have no adult connections, children who have been hurt and betrayed repeatedly. We serve adults whose own early trauma histories have never been attended to and who feel despair about the ways in which their symptoms have interfered with their parenting. The system we work within is certainly not always responsive or able to give people what they need. Where then do we find the hope?

I think we often assume that we have to give clients concrete facts in order to create hope. We talk about pointing out their strengths, and remarking on instances of improvement. We try to create opportunities for clients to learn and grow, and to experience success. All this is of course extremely important.

But I think we underestimate the hope that is created by forming an attuned, mutually respectful relationship. In such a relationship the client feels seen and heard. They feel a sense of belonging, of being part of something. Early templates about relationships always being associated with hurt and loss are challenged. The client gradually builds a secure base, a place he can return with triumphs or with pain. The client also builds an inner connection: he takes the treater into his mind, creating a caring voice that can soothe him in times of stress.

The very participation in a respectful relationship creates hope that there may be other relationships like this in the future. Maybe there are some people that can be trusted. Maybe love is a possibility after all. The opportunities in life expand.

As the relationship experiences difficulties (the child hits the staff member for example) and these are worked through and the relationship persists, new hopeful possibilities emerge. What if it is not true that whenever you do something wrong the other disappears? What if it is possible to get through hard times and reconnect?

One profound way that enduring relationships increase hope is through their effect on shame. Shame is the sense that deep within me I am no good, that I have a rotten center, and that anyone who gets to know me will turn from me in horror. But what if in fact this doesn’t happen? The antidote to shame is to be known, to share the secret self, and to have the other person not be repulsed. This is so hard to accomplish, because the person who experiences shame is so reluctant to share his true self, which he feels is so horrible. But if we are able to create a relationship that is strong and safe enough, and the client does share with us the parts they hide, we have a precious opportunity. By validating and not turning away, we begin to heal the shame. Consider how much hope flows into a person’s life as shame decreases, and the possibility of being a normal human emerges.

So, here are more reasons why we must emphasize the relationship as the vehicle of healing. This means providing time and space to build relationships, and creating policies and procedures that promote and honor them. It also means taking good care of our staff so that they have the stamina to stay open-hearted in these difficult relationships, and attending to the vicarious traumatization that is created by doing so.

And it also means paying attention to the personal transformation that can occur for us as treaters through increasing hope. Our own personal hope grows when we watch hope blossom in a child or a parent that has been wounded by life through no fault of their own, and who now is open to the possibility of love in their world.