Centre of Knowledge

Recovery from Relational Wounds: Attachment and Trauma Informed Practice Rudy Gonzalez Executive Director, Lighthouse Institute

What Do We Mean by Trauma? A frightening or distressing event resulting in a psychological wound or injury Resulting In Difficulty coping or functioning normally following a particular event or experience

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SingleComplex One-off, out of the blue, time-limitedRepetitive, prolonged, cumulative, chronic Impersonal – natural disaster, accidentInterpersonal, direct harm, exploitation, maltreatment Out of context – coming from a strangerIn the context of relationships, i.e. primary caregivers, significant others, responsible adult No relationship to a person’s place in lifeOften occur at developmentally vulnerable times – early childhood or adolescence Eg. Road accident, flooding, robberyE.g. Poverty, homelessness, incarceration, exposure to death/ violence These examples are for illustrative purposes only and are not intended to minimise the effects of any trauma on an individual

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)

Theoretical Underpinnings of TIP Attachment Theory Object Relations Theory Trauma Neurobiology Psychological Wellness Theory

Attachment Theory - Bowlby Bowlby used “attachment" to describe the affective bond that develops between an infant and primary caregiver. Attachment Theory Infants evolutionarily primed to form close and dependent bond with primary caregiver Promotes healthy social & emotional development by: Parental Responses → Patterns of Attachment → Internal Working Models Internal working models guide the individual's perceptions, emotions, thoughts and expectations in later relationships.

Dyadic Emotional Regulation Attachment is a form of dyadic emotional regulation. Infants incapable of regulating own emotions and arousal. 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.

Object Relations Theory - Winnicott Prime motivational drive in humans is to form relationships with others Style of relationship that develops in infancy to early childhood becomes part of an internal blueprint or a learned way of relating to others 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 self- object relations, the more rigid and resistant to change we become” (Klee, 2009).

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 Projection Projective Identification

Wellness can only be achieved through the combined presence of personal, relational and collective wellbeing Collective RelationalPersonal W

Impact of Trauma on Development Once the cycle of trauma begins the effects begin to spiral. Rather than the trauma being a one-off event it becomes an expected occurrence. The person becomes highly anxious and is unable to switch off from this state. This then interferes with all aspects of their daily life and makes it difficult to do any of the ordinary things, like, having fun, relaxation and the enjoyment of any nurture that might be available. So the person becomes increasingly deprived of the experiences that are necessary for growth and to redress the imbalance. Barton, Gonzalez & Tomlinson (2012)

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. Barton, Gonzalez & Tomlinson (2012) Impact of Trauma on Development Developmental vs. Chronological Age

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. 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)

Trauma Organised System Activity ClientWorkerManager

CLIENT Feel unsafe Angry/aggressive Helpless Hopeless Hyperaroused Fragmented Overwhelmed Confused Depressed STAFF Feel unsafe Angry/aggressive Helpless Hopeless Hyperaroused Fragmented Overwhelmed Confused Demoralised ORGANISATION Is unsafe Punitive Stuck Missionless Crisis Driven Fragmented Overwhelmed Valueless Directionless Parallel Process

Impact of Trauma on Organisations 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)

The Flow of Trauma Client Worker Manager

What is Recovery from Complex Trauma? The goal of therapy is to get children back on their developmental pathway Anna Freud Recovery is when the child has internalised the therapeutic process Rudy Gonzalez

Organisational Trauma Informed Practice - Systems Recovery Process Therapeutic Relationships The Group Therapeutic Environment The Organisation The Community

Organisations As Therapeutic Settings Organisation Internalised by the client Operations/ relationships attuned to the therapeutic task Relationships, language, communication, leadership and authority = Environment experienced by child All staff role model a healthy sense of community Variety of relationships & circle of care Provides a therapeutic milieu The Organisation as Therapist

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)

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

In Summary Early relationships create an internal blueprint for future relationships People from traumatic relational environments have difficulty in forming and maintaining constructive/healthy relationships The script can be modified however the more traumatic our early self- object relations, the more resistant to change we become Recovery is possible – the first tasks is to provide a safe, calm, and reliable environment Trauma informed practice influences every aspect of our work and encompasses key conditions for recovery Wellness is an ecological concept and can only be achieved through the combined presence of personal, relational and collective wellbeing