Tymur Hussein â Therapeutic Family Model of Care
Transcription
Tymur Hussein â Therapeutic Family Model of Care
27/03/2015 Centre of Knowledge Recovery from Relational Wounds: Attachment and Trauma Informed Practice Tymur Hussein [email protected] Director of Care Services, Lighthouse Foundation 3 Things Most Important to You What Do We Mean by Trauma? Difficulty coping or A frightening or distressing event resulting in a functioning normally following Resulting In psychological wound or injury Single a particular event or experience Complex One-off, out of the blue, time-limited Repetitive, prolonged, cumulative, chronic Impersonal – natural disaster, accident Interpersonal, direct harm, exploitation, maltreatment Out of context – coming from a stranger In the context of relationships, i.e. primary caregivers, significant others, responsible adult No relationship to a person’s place in life Often occur at developmentally vulnerable times – early childhood or adolescence Eg. Road accident, flooding, robbery E.g. Poverty, homelessness, incarceration, exposure to death/ violence Complex Trauma Because of this timeless and unintegrated nature of traumatic memories, victims remain embedded in the trauma as a contemporary experience, instead of being able to accept it as something belonging to the past. Kolk & Newman (2007) These examples are for illustrative purposes only and are not intended to minimise the effects of any trauma on an individual 1 27/03/2015 Theoretical Underpinnings Attachment Theory - Bowlby Bowlby used “attachment" to describe the affective bond that develops between an infant and primary caregiver. • Attachment Theory Attachment Theory • Object Relations Theory • Infants evolutionarily primed to form close and dependent bond with • Psychological Wellness Theory • Promotes healthy social & emotional development by: primary caregiver Parental Responses → Patterns of Attachment → Internal Working Models • Trauma Neurobiology • Internal working models guide the individual's perceptions, emotions, thoughts and expectations in later relationships. Dyadic Emotional Regulation Object Relations Theory - Winnicott Attachment is a form of dyadic emotional regulation. • Prime motivational drive in humans is to form relationships with others Infants incapable of regulating own emotions and arousal. • Style of relationship that develops in infancy to early childhood becomes part of an internal blueprint or a learned way of relating to others Require assistance of caregiver. As children become better at expressing their needs/ emotions, they learn self-regulation skills. However, this dyadic regulation never entirely disappears. There is a time for both types (self and dyadic) throughout a person's life. • Past relationships are replicated when we establish and maintain future relationships, which impact on our sense of identity • People from traumatic relational environments may have difficulty in forming and maintaining constructive and healthy relationships Object Seeking Behaviour “It is as if in early childhood we create a script for a drama and then spent the rest of our lives seeking out others to play the parts. This does not mean the script cannot be changed. However, the more traumatic our early selfobject relations, the more rigid and resistant to change we become” (Klee, 2009). 2 27/03/2015 Projective Identification In projective identification the person who is targeted with the projection begins to behave, think, and feel in a way that is consistent with what is being projected into him Collective W Personal Projection Relational Wellness can only be achieved through the combined presence of personal, relational and collective wellbeing Projective Identification Impact of Trauma on Development Developmental vs. Chronological Age An understanding of how the brain develops has significant implications for us in our work with traumatised people. It is natural that we first of all relate to a person in a chronological way. We see a middle aged person and we have normal expectations of a person that age. However, if a person has been severely traumatised in early childhood their brain may not have developed at a pace with their chronological age. If a person has been so traumatised that the limbic and cortex parts of the brain are largely undeveloped, this person may be functioning in many respects as a child. Impact of Trauma on Individuals On-going exposure to traumatic stress can impact all areas of people’s lives including biological, cognitive, and emotional functioning; social interactions/ relationships; and identity formation. Guarino, Soares, Konnath, Clervil & Bassuk (2009). Because people who have experienced multiple traumas do not relate to the world in the same way as those who have not had these experiences, they require services and responses that are sensitive to their experiences and needs. Barton, Gonzalez & Tomlinson (2012) Guarino, Soares, Konnath, Clervil & Bassuk (2009). Impact of Trauma on Systems A traumatised person may feel that a return to a chaotic and abusive environment is inevitable. So rather than wait for it to happen, they take control and try to provoke it to make things feel more predictable. Barton, Gonzalez & Tomlinson (2012) Activity Trauma Organised System Client Worker Manager 3 27/03/2015 Feel unsafe Angry/aggressive Helpless Hopeless Hyperaroused Fragmented Overwhelmed Confused Demoralised ORGANISATION Feel unsafe Angry/aggressive Helpless Hopeless Hyperaroused Fragmented Overwhelmed Confused Depressed Impact of Trauma on Organisations STAFF CLIENT Parallel Process Is unsafe Punitive Stuck Missionless Crisis Driven Fragmented Overwhelmed Valueless Directionless A traumatised organisation, like a traumatised person tends to repeat patterns of behaviour in a way that prevents learning, growing, and changing…and like individual trauma survivors, systems find it very difficult to see their own patterns. Bentovim (1992) Traumatic events and chronic stress can produce a similar impact on organisations. Without intending to do so, without recognising it has happened, entire systems can become trauma-organised. Bloom (2005) What is Recovery from Complex Trauma? The Flow of Trauma Client Worker The goal of therapy is to get children back on their developmental pathway Anna Freud Manager Organisational Trauma Informed Practice Systems Recovery Process Recovery is when the child has internalised the therapeutic process Rudy Gonzalez Therapeutic Relationships • Therapeutic Environment Michelangelo described his work as a sculptor as a process of removing the excess marble concealing the beauty of the figure within. His job, he was reported to have said, was a process of uncovering rather than creating. Working with people is often like this. Working effectively with people requires that you create and shape relationships that are therapeutic…. • The Organisation Fuller (1998) • Therapeutic Relationships • The Group • The Community 4 27/03/2015 Therapeutic Group Processes Recovery from injuries perpetrated in a social context must occur in a social context. These centers, responsible for healing, must become therapeutic communities where recovering is more important than control, and compassion and empathy drive out fear and coercion. (Farragher & Yanosy, 2005) When supervision takes place in a group setting, a greater range of feedback, support, challenges and viewpoints on clinical issues can be obtained. When group dynamics are managed effectively, and the emotional aspects of the supervision process are attended to, the group supervision setting can provide invaluable resources that are not available in the context of individual supervision. Andersson (2008, p.36 - 38) Andersson (2008, p.36 - 38) Therapeutic Environment Organisations As Therapeutic Settings Traumatised people benefit from caring environments that are attuned to their emotional states. All staff role model a healthy sense of community Where workers can adjust the environment to support emotional regulation, and can provide predictable responses and routines that assist in reducing hyper-arousal. (Tucci, Mitchell and Goddard, 2010) The Community Sense of community: The feeling that one is part of a readily available supportive and dependable structure. Sense of community transcends individualism in that to maintain such an interdependent relationship one does for others what one expects from others. Sarason (1974) Internalised by the client Provides a therapeutic milieu Operations/ relationships attuned to the therapeutic task Variety of relationship s & circle of care Organisation The Organisation as Therapist Relationships, language, communication, leadership and authority = Environment experienced by child Trauma Informed Practice • • • • • • • • • • Understanding trauma and its impact Culture of non violence Promoting safety Ensuring cultural competence Supporting consumer control, choice and autonomy Sharing power and governance Integrated care Healing occurs through relationships Those who care need to be cared for Recovery is possible 5 27/03/2015 Holding Hope for Recovery Hope is both the earliest and the most indispensable virtue inherent in the state of being alive. If life is to be sustained hope must remain, even where confidence is wounded, trust impaired. Erik Erikson (1964) www.lighthouseinstitute.org.au 6