Thankful this Thanksgiving

I guess I could follow the theme of the weekend by listing some of the work-related things I am thankful for this Thanksgiving:

1.       My book- I’m so happy and proud of this accomplishment and thankful for all the people that helped me realize it.

2.       All the smart, interesting, thoughtful caring people I have met through my training and consulting.

3.       The people I have come to know who really think about this work, develop new ideas, and strive to change the world. These include Steve Brown, Laurie Pearlman, Sandy Bloom, Kay Saakvitne, Martha Holden, Sarah Yanosi, and many others. It’s great to bounce ideas off of each other and thus come up with even better thoughts.

4.       The concept of vicarious transformation.

5.       My new friend at the UConn School of Social Work Megan Berthold whose courageous work with torture survivors has taught her a lot about surviving with dignity.

6.       The opportunity to teach at the School of Social Work- I’m going to teach a real credit course this semester!

7.       My wonderful supportive workplace, Klingberg Family Centers, with all its good humored and hard working people. We are developing new ways to provide excellence in trauma informed care.

8.       Our relationship with the publisher/owner of Risking Connection, Sidran Institute, Esther Giller and Elizabeth Power.

9.       Our work with our Risking Connection trainers. I am very proud of what we do to improve treatment excellence through our consultation groups. Our Day of Learning and Sharing with Ruta Mazelis looks to be another excellent event.

10.   Our new webinars offering training and consultation to our distant trainers.

11.   The fact that both Risking Connection and the Restorative Approach have just been accepted for inclusion on an Evidence Based List, the California Evidence Based Clearing House for Child Welfare.

12.   A new research project we have just been commissioned to do in the Yukon Territory in Canada.

13.   Our working on adapting Risking Connection to native Hawaiian values with Child and Family Service and Partners in Development in Hawaii.

14.    The marvelous people who are directly responsible for the Traumatic Stress Institute of Klingberg Family Centers: Steve Brown, Marci Marciniec, and our newly hired associate, Michelle Kenefick.

Happy Thanksgiving!

 

What Difference Do Templates Make?

I have been trying to figure out ways to convey to people the importance of a person’s basic templates about other people. These templates are formed early in life, before the baby has language. All of our expectations and actions are based on these templates. We see them as the way the world is, not as our ideas or opinions. The reason I feel it is so important to highlight these templates is that I have come to believe that our most important task as treaters is to change these templates from “people can’t be trusted and they hurt you” to “some people are trustworthy and can be a source of joy and help.” If we understand that, it changes how we approach treatment.

I devised the following exercise to demonstrate the effect of templates. To use this for training, I would divide the group into smaller groups. Give each group a pair of scenarios. Instruct them to consider what each youth is feeling, and what they are likely to do next. What might be the difference between the ways that the two youth would react? When they are done, each group should choose a member to portray the youth. This person should read the scenario then continue with “I am feeling… What I plane to do about this is… “Hopefully what will come out is that kids who have had good experiences with people are more likely to ask for help and hide problems without getting into trouble. Kids who have had bad early experiences with adults are more likely to think that they have to handle the problem themselves and more likely to use violence and threats, because those are the only solutions they know.

Here are the scenarios:

My name is Daquan. I am 15, and my life hasn’t been that great so far. DCF took me out of my family when I was five, and I have been moving around a lot since then. I live in a foster home, and DCF gave me this scholarship to send me to camp. One of my bunk mates, Seth,  is bigger than me and he has been threatening me, demanding to wear my clothes,  and saying he is going to beat me up. I don’t know what to do..

My name is Darrell. I am 15, and I live with my mom and dad and little brother, Joey. We mostly get along pretty well. My school gave me this scholarship to send me to camp. One of my bunk mates, Seth, is bigger than me and he has been threatening me, demanding to wear my clothes, and saying he is going to beat me up. I don’t know what to do..

My name is Bianca. I am sixteen years old. I live in a group home. I’ve always hated school and I don’t do well there. I especially don’t understand math and this year algebra makes no sense at all to me. Yesterday the teacher called on me and I had no idea of the answer. I mumbled something and left for the bathroom. I don’t know what to do.

My name is Estelle. I am sixteen years old. I live with my mom and dad and three sisters. We all love each other except sometimes my sisters drive me crazy. I’ve always hated school and I don’t do well there. I especially don’t understand math and this year algebra makes no sense at all to me. Yesterday the teacher called on me and I had no idea of the answer. I mumbled something and left for the bathroom. I don’t know what to do.

My name is Kyle. I have just moved into a foster home- I don’t even know how many I have been in since I was taken from my family when I was six. Last night I was at a party at a friend’s house. There was a lot of drinking and some kids were doing drugs. The noise and rowdiness kind of got out of hand and next thing I knew the police were called. I didn’t know what to do.

My name is Tommy. I live with my grandmother and I love her very much. She has always raised me to know right from wrong. Last night I was at a party at a friend’s house. There was a lot of drinking and some kids were doing drugs. The noise and rowdiness kind of got out of hand and next thing I knew the police were called. I didn’t know what to do.

My name is Sarah. I lived with my mom until I was 12, and she had some serious problems. I am 18 now. I lived in a shelter and then some foster homes. I got pregnant last year and now have my wonderful baby Melissa. But some nights she cries and cries and just won’t sleep. I don’t know what to do.

My name is Rebecca. I am 18 now. I lived with my mom until I got pregnant last year. Mom was upset, but she and my Aunt Susie stood by me. Now have my wonderful baby Melissa. But some nights she cries and cries and just won’t sleep. I don’t know what to do.

My name is John. I grew up with a lot of violence, and my Dad is in jail now for killing someone. My mom just seems to bring home these angry guys. I am 18 now, I’m sharing an apartment with two friends and I have a job. I still get some help from the state. One of my roommates is driving me crazy. He is a real slob and leaves his stuff everywhere, never cleans up after a meal. I have complained to him but he has not changed. I don’t know what to do.

My name is Rick. I grew up with my mom and dad and brother. I am 18 now, I’m sharing an apartment with two friends and I have a job. My mom makes me food and sometimes still does my laundry. One of my roommates is driving me crazy. He is a real slob and leaves his stuff everywhere, never cleans up after a meal. I have complained to him but he has not changed. I don’t know what to do.

Please click on “comment” and let me know what you think about this approach. Especially if you try it with your staff, PLEASE write me and tell me how it goes.

Just think what our lives would be like if we thought our most important task was to teach our clients that people can be associated with pleasure,

 

 

Who Are These Big People?

When a baby is very small, before she has language, she is already investigating the world in which she lives and coming to conclusions about what kind of place it is. Most importantly, she is learning about the people around her. Who are these big people? How do they treat me? When one of them comes over to me, do I generally feel better or worse?

 In good enough parenting, the presence of a person is usually associated with pleasure. I am hungry, someone comes and feeds me and I experience pleasure. I cry, someone rocks and soothes me.I am wet, someone changes me. The baby gradually discovers that she can do things to affect these people: she cries, they come; she smiles, they smile; and she enjoys many other positive interactions. Since the baby has no language at this point, she cannot create a narrative of these experiences. Instead the are stored deep in her body as a template, a pattern, a set of assumptions about how the world is. As the child grows older, she does not understand this view of the world to be an opinion based on her experience; she feels it as the truth about how the world is. These truths of course influence how she acts in the world.

If a baby is neglected or abused before she has language, she too forms a template about how the world is. She too knows the truth about other people: no matter what you do they don't come; if they do come they are often harsh and angry ;they don't undertsand what I need; sometimes they hurt me; they often seem upset that I need anything. This baby too grows up with deep unexamined assumptions about the nature of the world; this girl too acts based on those assumptions.

A person does act differently based on what they know about the world around them. Imagine that you have just started a new job that you are very excited about. On the third day you get an email from the CEO of the company asking you to meet with him the next day. You are scared and surprised, and you wonder what this is about, so you ask a co-worker. The co-worker says, "oh, don't worry, he meets with all new employees. He is a great guy, he loves to help new people and make sure they have the resouurcves to learn and develop in the company". How would this infludence your subsequent preparatione for the meeting? How would it influence how you act in the meeting?

Oh the other hand, imagine that when you ask your co-worker about the meeting she says: "Oh my God, I'm sorry to hear that. The CEO here is a total idiot. He's always yelling at us for something. When a new person is hired he always tried to intimidate them into performing well. He has to establish that he's the boss and tell you what will happen if you do anything wrong." How would this infludence your subsequent preparatione for the meeting? How would it influence how you act in the meeting?

We act differently towards people based on our unexamined, unarticulated assumptions about them.

Luckily, even though these templates are formed early and stored deep in the lower part of the brain, they can be changed. Our central job in treatment is to change the child's assumptions about people from: people are mean. You can't trust them and they hurt you. Best to stay away from them and take care of everything your self. to: people can be nice. Some are trustworthy and will gladly help you. Some will love you. Connections with others will make your life better and easier.

So how do we do that? We think about all the qualities we wish the child expected in other people. Then we ourselves exemplify those qualities. And we create positive, pleasurable, fun interactions for the child with adults. We include many pleasurable activites that involve physical activity, rythym, movement, art, music, dance, etc. this will open the lower brain so that more change is possible.And we have to continue doing these things over and over again for a long time. The brain can change, but it takes many repetitions especially to change early templates stored in the lower brain.

So, that's pretty amazing. It turns out that behavior will change not primarily because it is punished, but primarily because the child's view of the world and other people gradually changes. As she begins to feel safer and to associate adults with pleasure she will no longer need to utilize extreme behaviors to push people away. Therefore, all people in treatment programs must emphasize having fun with the kids and making sure than most of their interactions are pleasureful. Sounds like a fun job to me!

The Restorative Approach Training

I have been working very hard on completely revising my Restorative Approach one day training. It now follows the order of my book (Trauma Informed Care- The Restorative Approach www,nearipress.org). The exercises consist mainly of scenarios. The training includes many useful tools. I strongly urge anyone who is interested in the approach to attend my day long training at Klingberg on the 29^th, even if you have attended a previous one. Besides, everyone who attends that training will get a copy of my book! If you can’t do that, I hope to see you at a training in the future. As you can see I am very excited about this new presentation. 

Here is the outline:

I.              The trauma framework, a useful road map to understanding both the effects of trauma and how people can heal.

II.            The Treatment Model

a)                  Overview

b)                 Use of Brain Science

c)                  Day-to-day Operation (Attunement exercise)

d)                 Common concerns

III.           Case examples demonstrating the daily workings of a trauma-informed treatment program. Handout: Scenarios

a)                  Defining and discussing behavior: Cassidy, Sarita and Dahlia

b)                 Managing challenges: Marcus, LaTasha, Juan, Young Love, Jesse, Taking Responsibility

c)                  Holding our values during hard times: Kathy, Katrina, Aaron, Trevor and Mario

IV.          Responding when children hurt others.

a)                  Theory of change

b)                 Rewards and punishments

c)                  Joquim Plays Basketball

d)                 Exercise: Becoming More Like You (Handout)

e)                  The Restorative Task, a response that incorporates opportunities for healing and for making amends. Handout: Formulation and the Restorative Task

f)                   Exercise: Formulation Jeffrey and Alexandra

g)                  Exercise: Restorative Task: Jeffrey and Alexandra

h)                 Taking Responsibility

i)                     When the program feels like a war zone  (Handout)

V.           The role of the clinician in trauma-informed care

a)                  Characteristics of clinicians who will succeed in this system

b)                 Necessary training

c)                  The clinician and the team

d)                 Treatment planning

e)                  Supervision and Support

VI.          Trauma-informed care and families.

a)                  Parents as trauma survivors. Exercise: Laura

b)                  Need to feel safe and to build trust. Exercises: Jaquanda, the Johnson family

c)                  Recognize and honor their strengths

d)                 Family fun and joy.

e)                  Psycho-education

f)                   RA at home

VII.         The Restorative Approach and Foster Care

a)                  Training

b)                 Special Needs of Relative Foster Parents (Handout)

c)                  Defining Behavior

d)                 Not Giving Up

e)                  Handling Problem Behaviors Handout: Exercise:  Joseph Visits his Bio Mom, the Contingent Life, Handout: Behavior Management in Foster Care

f)                   VT

VIII.       Agency support for trauma-informed care.

a)                  Leadership Exercise: Problems in the Treatment Team

b)                 Structure

c)                  Culture Exercise: Boundary Questions

d)                 Physical plant

IX.           Staff development.

a)                  Hiring

b)                 Training

c)                  Supervision

d)                  Promotion

e)                  Skill building

f)                   Staff turnover

g)                  Attention to vicarious traumatization

X.           Sustaining the change

a)                  Forces pushing towards a punitive approach

b)                 Predicting and addressing challenges

c)                  Measuring and celebrating progress

d)                 Celebrating success will help sustain the transformation

 

The Book Everyone is Talking About

I just finished the book How Children Succeed: Grit, Curiosity and the Hidden Power of Character by Paul Tough, Houghton Mifflin Harcourt, Boston New York 2012. This book has received a lot of media attention. For example, was reviewed in the NY Times Book Review (http://www.nytimes.com/2012/08/26/books/review/how-children-succeed-by-paul-tough.html?pagewanted=all&_r=0 )  Paul Tough was also featured on This American Life. (http://www.thisamericanlife.org/radio-archives/episode/474/back-to-school ).

To give an overview of the book I’ll quote the New York Times: “This book challenges the belief that success today depends primarily on cognitive skills — the kind of intelligence that gets measured on I.Q. tests, including the abilities to recognize letters and words, to calculate, to detect patterns — and that the best way to develop these skills is to practice them as much as possible, beginning as early as possible. In his new book, “How Children Succeed,” Tough sets out to replace this assumption with what might be called the character hypothesis: the notion that noncognitive skills, like persistence, self-control, curiosity, conscientiousness, grit and self-confidence, are more crucial than sheer brainpower to achieving success….” These skills can actually be taught, but a significant factor is that “Character is created by encountering and overcoming failure.”

However, I’d like to concentrate on the ways that this message interacts with our work. In his attempt to discover what factors actually contribute to adult success, Tough first describes the ACES study, and give an excellent concise report of the correlations discovered in that study between childhood traumatic events and later psychological and medical problems. Interestingly Tough reports that even when only the subjects who didn’t smoke, were not overweight and did not use drugs were examined, there was still a high direct correlation between the number of ACEs and the incidence of heart disease. Tough explains the biochemistry that produces this result through the stress response. He makes the connection between traumatic events, stress and poverty. So, this underscores our growing understanding how early childhood traumatic events change children’s biology and affect the rest of their lives.

Then Tough reports on the science of attachment, which shows beyond a doubt that attachment with a caring adult predicts future success. In fact, Tough states later that attachment can overcome the stress of traumatic events (connection is the antidote to trauma). He specifically describes how the chemistry of attachment counteracts the chemistry of stress.

Tough moves on to the central point of his book, which is the importance of teaching the executive functioning skills, which he names character. As mentioned above, these are persistence, self-control, curiosity, conscientiousness, grit and self-confidence. I think this fits in with our teaching by underscoring the importance of specifically teaching skills; through curriculums, experiences, and through modeling and demonstrating. He gives many specific ideas for doing so (one of which is playing chess). An interesting point is that children learn partly from experiencing and triumphing over failure. Affluent kids, he postulates, don’t go through enough failure or demand for hard work because everything is set up for them to succeed. Poor kids, on the other hand, don’t get enough help triumphing over failure and seeing it as temporary and not because of a character failure.

I would have liked more exploration of how these various factors interact with each other. Maybe that’s the next book. But it is great that this book is getting so much attention, and publicizing the ACEs study and the importance of attachment. I highly recommend it.

Hope

I thought since I was last talking about hope, I would share some quotes about it. These came from the NASW National Conference, the theme of which was Restoring Hope. It would be interesting to print these out and discuss them in a staff meeting, always wondering- how do we promote hope in our clients and in ourselves?

“At bottom, everything depends on the presence or absence of one single element in the soul- hope.” Henri Frederic Amiel

“There is no such thing as false hope”  Elizabeth J. Clark

“Hope and hopelessness are both choices. Why not choose hope?” Greg Anderson

“Hope is the dream of waking man.” Aristotle

“Where there’s hope, there’slife. It fills us with fresh courage and makes us strong again.” Anne Frank

“Courage is like love. It must have hope for nourishment.”  Napoleon Bonaparte

“We should not let our fears hold us back from pursuing our hopes.” John F. Kennedy

“We must accept finite disappointment, but we must never lose infinite hope”. Martin Luther King, Jr.

“There is no medicine like hope, no incentive so great, and no tonic so powerful as expectation of something tomorrow”. Orison Swett Marden

“Were it not for hope the heart would break.” Thomas Fuller

“Is there a social worker who, though he is weary, tense and with a soul worn threadbare, is not ready to start work all over again in this cause?” Nora Deardorff

It Ain't Easy Being RICH- Hope

Anyone who has taken the Risking Connections â training knows that a key element is that the path to healing is through a RICH relationship- one that includes Respect, Information, Connection and Hope. This is such a central point that the publisher, Sidran, has copy write protected the concept independently. In our training we ask participants to share ways in which they are currently demonstrating RICH with the clients, and also with each other in their team. Because amazingly it turns out that what the clients need in a relationship is the same as what we need for ourselves.

For four weeks or so I am going to right about the dark side of RICH- by which I mean the difficult and complex aspects of creating RICH relationships. These are the areas where we struggle, stumble, and sometimes become less than helpful to our clients and each other. Let’s look at each part of RICH and discover what is hard about it and how we can overcome the challenges.

This fourth week I will focus on Hope.

Hope is the foundation on which all the other qualities rest. In the dictionary hope is defined as: “to cherish a desire with anticipation;” “to desire with expectation of obtainment;” and “the feeling that what is wanted can be had or that events will turn out for the best.”

I previously posted on Hope on 4/15/12. The focus of that post was the ways that a RICH relationship in itself creates hope, independently of the external reality.

Not surprisingly, the Risking Connection curriculum (Saakvitne, K., Pearlman, L., Gamble, S., & Lev, B. (2000). Risking connection: A training curriculum for working with survivors of childhood abuse. Lutherville, MD: Sidran) has quite a bit to say on hope. The authors maintain that holding hope is a key responsibility of the therapist. Our clients come to us hopeless, and they often experience setbacks that discourage them further. Meanwhile, we are doing this difficult work in the middle of an ineffective and inadequate child welfare system. So, it is possible for both the treater and the client to become hopeless. It is the treater’s responsibility to take care of him/herself and do whatever is needed to fight vicarious trauma in order to maintain hope. The treater’s job is to “Hold onto vision of the survivor’s potential future self,” and to “serve as trustees for the survivor’s future possibilities.” (RC pp.15-16) The treater is at her best when she can see clearly the client healed, living a productive life. The treater must maintain the tension between seeing that version of the client’s potential and also seeing the current reality of the client. The authors ask us to direct our attention to evidence of hope and resiliency in our client’s stories. When presenting or discussing a case, talk about strengths in a real rather than pro forma way. They also point out that hope is fueled by compassion for our clients. If we understand the adaptive nature of their symptoms, we feel less exasperated and less personally attacked. In other words, having a theory, a road map, that helps you understand the behavior and plan your next treatment intervention creates hope that counteracts the bewilderment and discouragement we usually feel in the face of extreme behaviors.

What is the meaning we ascribe to our client’s behaviors? When Aisha ran away and became involved in dangerous situations, Louis reacted: “How can she be so stupid! We have explained a thousand times that she is putting herself at risk. In fact, I just had a great talk with her last night about this! I told her how worried I was about her when she put herself in such danger. She told me she understood and would not run away again, and she thanked me for spending time with her. I guess she was just manipulating me to be able to stay up longer. She doesn’t care about me or anyone else. She doesn’t even want to get better. She’ll probably end up being kicked out of here just like our last two clients. Sometimes I wonder why we even bother.”

Mario was also affected by Aisha’s running away. He said: “I am so scared for Aisha. She still doesn’t value herself enough to keep herself safe. And we haven’t yet been able to teach her an alternative to running, or to make her safe enough to try it. I wonder if we set up a place on grounds where she could run and stay until she calmed down enough to come back if that would help her. And when I think of it, I realize that Aisha has been forming some close connections with both me and Louis. I wonder if that is scary to her, especially since we are guys? I’m going to talk to Tracy, her therapist, about that, and bring it to team. I don’t  know what we should do differently but maybe there is something. Aisha is so bright and has so much spunk. I know she has a great future if we can just find a way to get her there.”

The enemy of hope is vicarious traumatization (VT). Since it is the treater’s responsibility to maintain hope, it is essential that we combat this aspect of VT specifically. Some strategies, largely taken from the Ricking Connection curriculum, include:

·         Challenging negative thoughts and looking for evidence of resiliency

·         Celebrating all kinds of successes

·         Collaboration with others, within our agency, outside, and even outside our treatment community. For example, when a local business joins us and gives backpacks to all the students returning to school, it helps to know that there are others outside our world who care.

·         Noticing the advances in understanding trauma and in treatment that are being discovered through science and new technology.

·         Appreciating the gifts of the consumer movement.

·         Cultivating our spirituality, whatever that may be

·         Look for meaning and inspiration in everyday events and in natural beauty

·         Seeking and embracing the personal transformation that comes with this work. How has this job, and being involved with these clients, changed you for the better? What have you learned from them? In what ways have you grown?

There are also many ways the agency can help workers fight VT and remain hopeful- another time, another post.

Hope is an essential element of every moment of our work. In fact, our work defines hope- we embody a conviction that people can heal and change. We have seen it happen many times.  As we are presented with each new scared, snarly, obnoxious, difficult client it is our job to shine with the hope of all that they can become.

 

 

It Ain't Easy Being RICH- Part Three: Connection

Any one who has taken the Risking Connections â training knows that a key element is that the path to healing is through a RICH relationship- one that includes Respect, Information, Connection and Hope. This is such a central point that the publisher, Sidran, has copy write protected the concept independently. In our training we ask participants to share ways in which they are currently demonstrating RICH with the clients, and also with each other in their team. Because amazingly it turns out that what the clients need in a relationship is the same as what we need for ourselves.

For four weeks or so I am going to right about the dark side of RICH- by which I mean the difficult and complex aspects of creating RICH relationships. These are the areas where we struggle, stumble, and sometimes become less than helpful to our clients and each other. Let’s look at each part of RICH and discover what is hard about it and how we can overcome the challenges.

This third week I will focus on Connection

Connection is the central concept in a trauma-informed approach. People heal within relationships. Our programs should offer our clients RICH relationships and train staff how to utilize these relationships for the most powerful healing.

Some of the complexities of this approach become clear when we talk about the fact that relationships have two sides- the clients and ours. These relationships affect us too, and all of who we are shapes the relationship.

On April 9, 2009 I wrote about the Restorative Approach and Boundaries. In this post I discussed some of the common complexities that arise from our caring for the children and wanting to help them. People sometimes assume that because the Restorative Approach emphasizes relationships and speaking from the heart, we are throwing out the idea of boundaries. Quite the opposite is true! For relationships to be safe and healing, the boundaries must be clear, reliable and trustworthy.

Because abuse is in its essence a violation of boundaries, it is especially important that we pay attention to boundaries when working with abused clients. Our children have experienced major boundary violations, such as sexual abuse. They have also experienced many other chronic, less obvious boundary problems. Many of our children have had to handle responsibilities far beyond was is reasonable for their age, such as an eight year old being responsible for her two year old sister. They have been way too involved in adult issues, such as being worried about the rent or finding food. They have been exposed to adult sexuality and to relationship worries. They have had to parent their parents- care for a sick mother, listen to parental problems, help ease a parent’s depression.

So many tem[potations can arise for staff. We may want to give the kids gifts; take them to lunch; give things or money to the family; etc. The family may give the therapist a gift. We consider sharing personal information, either because we feel close to the client or we think it would help them. The client may tell us a secret, on the condition that we don’t tell the rest of the team. When the child is leaving, we may consider giving her our email address. We wonder if we should give this boy a hug.

In our training, we emphasize that as a staff you should TALK ABOUT every decision that is outside your job description before saying anything to the child or family. Talk with your supervisor or your team. It may be just the thing to do; it may be dangerous to the child or the group. But it is much easier to make the right choice when you step back, take time to think, and talk with someone else.

That we even have these dilemmas illustrates how much the kids and family matter to each of us. And so, with each of these real connections comes our exposure to the pain the child is feeling.  When a sad thing happens to the child, we feel it too. It is often hard to stay with that pain- we often just wish to fix it. Part of that impulse is to sheil ourselves from really experiencing the painful worlld of the child.

And we experience losses. We don’t talk much about what it is like to take these children into our hearts, and then have to discharge them- often to a less-than-optimal situations. One person in my agency used to say (when we had residential) “You know they are ready when you don’t want them to leave.” But they do leave, and staff are expected to be ready to open their hearts to the newest snarling child. It’s a hard thing to do, and one aspect of Vicarious Traumatization. It’s good to talk about this in our teams, especially every time there is a significant positive or negative discharge.

One more thing about connection and our part of the relationship. We cannot open our hearts to these clients if we are feeling lousy. If we feel hopeless and incompetent; if we feel mistreated by our boss or the agency; if recent encounters with clients have been scary or hurtful. We will not be available for new relationships. A new admission will be greeted with cynicism or distant formal interactions. This is why a trauma-informed relationship based approach cannot work unless we take care of our staff. How do we do that? Imbed discussion of VT. Schedule time to think, reflect and get support. Provide regular supervision for everyone. Utilize a clinical road map to make sense of the behavior. Have retreats, Have many systems for staff recognition. Do fun things together like potluck lunches and sports.  Time spent in these activities will be completely repaid in more effective treatment, less physical interventions, and less turnover.

Connection. It’s been a scary thing in the children’s lives. It has its complications in our own lives. Yet it is what makes us human and what builds our brains. Let’s look at our settings and consider how we are supporting connections in the way we do things.

I’d love to hear your ideas about ties. Just click on “comment.”