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.
Thanks!
Linda
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
http://tfcbt.musc.edu/ 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 www.neari.org
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!
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