Some years ago a professor of oriental religion went to see a Zen master. “Please teach me about Zen,” he said. The Zen master was busy making tea, and when all was ready he started to pour the clear, steaming, green liquid into the professor’s cup. He poured til the cup was full, and then went on pouring, and the tea went all over the table, and onto the floor. “Stop!” said the professor, “The cup is full and there is no room for more tea.” “My precise point, ” said the master, “How can I teach you anything new when your head is already full.”

Zen story.

In the same way that different societies have their own ways of doing things, the habits and practices that make up the unique culture of that society, organisations also develop their own individual ways of coping with the work that they undertake. They too have their cultures, some of which are helpful to clients, some are neutral, while yet others are actually unhelpful.

All cultures are based on one simple idea, the idea that this is how we do things around here. Sometimes the mental models that a service holds at the centre of its treatment approach, and which underpin its entire philosophy of therapy, seem to work against the best interests of the group it was set up to help.

This may happen because the latest research has moved the story on, and the changed paradigm that has resulted has yet to trickle down, or sometimes such a state arises due to the aberrant beliefs, or long term practices of one or more charismatic staff, often seen as representing the culture holders of the organisation.  Many of the worst abuses in social care homes seem to have resulted from this kind of situation.

Trauma Informed Care is one of these newer paradigms.  A positive model that is being seen as a useful guide to inform the provision of services for those who have suffered developmental, attachment, or other complex traumas during their development. Such traumatic experiences interfere with the victims’ ability to regulate their emotions and automatic behavious, to form secure, reciprocal relationships and to think effectively when under stress.  This represents a group of people who have very well-developed fight or flight responses, that have arisen through living in physically, or emotionally dangerous environments, at crucial stages of their development.  People whose survival mechanisms continue to work too well.

When abuse occurs, the result is often hyperaroused people who show dramatic responses to what appear to the rest of us to be insignificant events.  Neglect, on the other hand, can produce underaroused people who are less emotionally responsive than might otherwise have been expected. In either situation they show reactions to events that lie outside the norm for most people, and they can subsequently be seen as either uncaring or over-emotional, manipulative and attention seeking.  They attract diagnostic labels such as Borderline or Antisocial Personality Disorder, which can all too easily becomes  pejorative labels that prevent access to care, and not ones that should facilitate their help seeking behaviours.

One of the main problems for services and those who work in them is that, to some extent, they have to go through the same processes as their clients when they attempt to change how they work.  Unlearning their current behaviours and the belief systems that underlie them, and then to replace them with new, more helpful way of understanding their clients’ difficulties.  Like our clients the services have to learn to use this new vision to develop new ways of living  in an altered world, ways that free them up and not ones that tie them down. We have first, to imagine that things can be different if we are to be able to work towards a more fruitful future.

For unlearning to occur, a participatory process is needed that enables a group to decide what is important to remember and what it is safe to forget. Sandra L Bloom

One of the key things here is to help the process of unlearning move forward.  Giving up the hard-won knowledge (often over many years) about ourselves and our world, and then being able to start to challenge this world view and to replace it with something new, something fresh, something more helpful.

Moving away from a  damage model to one based on the concept of the trauma organised brain, introduces a more fluid set of possibilities into the treatment interaction.  We can move from the idea of “fixing” something, to the concept of using the construct of neuroplasticity to bring about a lasting transformation for our clients in a collaborative partnership.  A process that requires us to develop new ways of thinking about and applying our hard-won skills to an altered therapeutic environment.

 A recovery model demands that we reassess our assumptions about how we choose to define success.

We may be doing the same thing but thinking about it differently.  No longer seeing ourselves as people who cure, but instead as facilitators, allowing the client to develop their own path to recovery within the therapeutic setting. A recovery model demands that we reassess our assumptions about what defines success.

There are advantages for both the client and the organisation in going through this process of thinking aobut how to change the way that we work together. The client comes up against a service that is more flexible, and better able to adjust to the changing nature of their presentation, often ins way that allow the right intervention to be offered to the client almost before it is needed. Services in their turn develop staff that are able to manage their client’s strong emotions more effectively, and without developing burning out to the same extent.

Trauma Informed Care also exposes us to the possibility of learning from vicarious resilience, the chance to witness, and then to learn from our client’s increased ability to bounce back from the vagaries of life in the twenty first century, as we help those in great distress to cope better with whatever life throws at them, and to live increasingly fulfilling and enjoyable lives.

 

 

If you are interested in these concepts I would be glad to hear your views and to read your comments.

I would also recommend the work of Sandra L Bloom and Brian Farragher, summarised in their trilogy of books on the Sanctuary Model.

Creating Sanctuary.

Destroying Sanctuary.

Restoring Sanctuary.

 

All published by Oxford University Press