I recently attended a two-day training course organised by Caidreamh and facilitated by specialist clinical psychologist, Dr Karen Treisman on Relational and Developmental Trauma. Karen was recently awarded a Winston Churchill Fellowship Travel Award and was named the 2018 Psychology Professional of the Year Award for Excellence in Attachment and Trauma.
I was truly impressed by Karen’s wealth of knowledge and considerable professional experience/clinical experience in this highly specialised area. As a trainer with Ag Eisteacht, I am aware of “the power of relationship” and the effect it can have on our physical and mental health.
This training reinforced this knowledge and made me even more enthusiastic and positive about the need to spread the importance of “connection”, both professionally and personally.
Coming from a background of nursing and health promotion and working directly with vulnerable families in the community, this training made sense to me. It gave me confidence that the work I do really matters and that it makes a difference to the lives of vulnerable children.
I was fascinated by Karen’s skilful use of art and psychology to connect with the most at risk children in our society in a kind, non-judgmental and fun way. Karen Treisman’s training was powerful and insightful. She is a true champion of children and their care givers in this extremely important field of childhood trauma.
Overview of the training
The following is very much a summary and simplification of what was covered by Karen.
This packed two-day training offered a solid introduction to the concepts of relational and developmental trauma and how it impacted on children’s brains, bodies, emotions, relationships and behaviours. Day two looked at the application of these concepts in practical and therapeutic ways.
Relational trauma is trauma that has occurred in and by relationships. It impacts what you expect from relationships and how you are in relationships. “Relational trauma requires relational repair” (Treisman 2016). Every interaction is an intervention (Treisman, 2018) and all of us have something that we can bring. Over the course of the two days it became very evident that “Relationships are the oxygen of human development.” (Peter Bensen)
Relationship and connection begins in utero even before baby is born and are fundamental to feeling safe and secure in a complex world. Babies are born with autoregulation. They are in survival mode where they eat, eliminate, sleep, breathe and cry (basic functions). In co- regulation, the carer uses themselves – their tone of voice and body language – to help baby to up regulate when they are bored or tired and down regulate when they are overstimulated or agitated. The care giver consolidates this learning by repeating the caring practices time and time again. This predictable and developmentally appropriate care enhances the attachment process and the carer becomes the secure base for the child.
In a positive and protective child-carer relationship; and through positive interactions. Baby learns and internalises many different positive beliefs about themselves, others and the world – including (there are various different types):
• I am seen, heard and loved
• Others are predictable and caring
• The world is good and safe
The relationship and attachment experience can be negatively affected when there is a relational trauma, adverse childhood experiences, and exposure to alcohol and other substances in utero. The child’s brain can become wired for fear. They can remain very much in survival mode as they do not have a secure base to rely on and help them feel loved, safe, seen and heard. Trauma is thought to often have significant implications for the development of children’s cognition, language and self-identity.
When there are more negative, hostile, or absent parenting experiences; such as where the attachment or the relationship is lacking to such an extent that it is more difficult for the child to reach their potential,
Baby might learn, for example, that
• I am invisible, not lovable
• Others are unpredictable and uncaring
• The world is scary, and unsafe?
Children need to learn different ways to do ‘relationship’. It is up to those who work directly with these children to “model the model” (Treisman, 2016) and actively demonstrate positive relationships through their own interpersonal interactions. How we talk to children becomes the child’s inner voice (Peggy O Mara).
Children who suffer relational trauma may have a reduced ability to emotionally regulate and may be younger socially and emotionally than their peers. They can be more “triggered” by certain people, places and circumstances. This can cause them to react more quickly when they feel threatened and take longer to calm down. For some children, the survival brain in a child who has suffered trauma is switched on more frequently. The effects of toxic stress means the young person might be on high alert and ready to move into fight flight or freeze at any time.
Professionals working with these children would be best placed to intervene early before the young person is triggered or after some time, when they have calmed down. “We need to regulate before we can reason” (Bruce Perry).
As professionals and care givers we are encouraged to rethink how we work with young people. To consider exploring creative and expressive tools, as opposed to purely relying on words and cognitive means of communication. This has the potential to enrich the relationship and create more sparkle and meaningful moments and connections.
The use of metaphors to describe what it feels like for a young person who has experienced trauma.
Every young person is unique, within a unique family and context. It can be multi-layered and complex. When working with these children, one size does not fit all (Treisman, 2016). The trauma experienced by some children may not be dramatic or even obvious. It may be a low dose or a series of events accumulating over time resulting in neglect. Karen Treisman highlights what we have heard said before by many researchers is that “neglect gets neglected” and can be more detrimental for a child than any other form of abuse or trauma. Neglect can fall under the radar.
A deserted island
Karen Treisman used the metaphor of “a deserted Island” to potentially be a way to symbolise isolation, solitude, abandonment to describe this neglect. When we are in our survival brain it is harder to think. We revert to habitual or defaults patterns. Some people feel like they are fire-fighting as they move into fight flight or freeze mode. The metaphor captured in the book “Working with relational and developmental trauma by Dr Karen Treisman” of “swimming in shark infested waters” is effective. Feelings of being surrounded, threatened, on edge, frozen, all represent the feeling that a child who has experienced trauma may feel when triggered. Reactions and coping methods may range from retreating like a tortoise, feigning dead like a possum, fighting back or becoming just like the shark.
Karen spoke of helping young people connect with their thoughts and feelings to help them understand their behaviour and the world around them. She reiterated the importance of meeting the young person on their level, being mindful not to story them in any way or to have any preconceived ideas. Starting with a sense of curiosity, creativity and non-judgement is encouraged to try to explore what it like for the young person. How they view themselves, how they perceive others see them and how they see the world. Some professional environments can be trauma-inducing rather than trauma reducing (Treisman, 2018). Being mindful of triggers, creating safe spaces and taking time just “to be with” these children in our care is essential for positive relationship building. Ultimately, we need to strive to help the children “to be the rainbow in the storm.”
We are reminded to slow the process of relationship building down in order to build trust. The quote below by Robert Frost offers a word of caution. It advises us to treat all children individually and to take the time to get to know them. Being trauma informed as an individual and as an organisation optimises relationships and enhances healing and repair.
Being trauma informed as an individual and as an organisation has the potential to optimise relationships, enhance healing and repair and provide insight into the complex lives of vulnerable and at-risk children in our care.
My hope is that I will now take this information into my practice and see the young people whom I work with on a daily basis with ‘new eyes’ and renewed energy. I hope to create opportunities for sensitive and empathic engagement and to consider alternative and creative ways to reach out and create more “sparkle moments”.
Karen Treisman has a wonderful selection of useful therapeutic evidence-based tools and books for professionals to use to work in a creative way to tap into ways young people can express their feelings, thoughts, hopes and dreams. These can be found here.