An Understanding of Trauma
written by Betsy de Thierry 2014 ©
Trauma is defined as an experience that is overwhelming and hinders the child’s safety and security. It always involves some kind of terror and powerlessness.
Traumatic stress is caused by exposure to or witnessing of extreme and potentially life threatening events. Traumatic exposure may be brief in duration (e.g. an accident), or involve prolonged, repeated exposure (e.g. sexual abuse). The former has been referred to as “Type I” trauma and the latter as “Type II” trauma (Terr, 1991). Knowledge of traumatic stress – how it develops, how it presents, and how it affects the lives of those who suffer with it – may be the first step towards being able to interact positively with those affected by it.
Alongside the categorisation of Type I and Type II trauma, there is an increasing recognition of the consequences of interpersonal trauma, in terms of attachment theory, which is now acknowledged in many children’s settings. Traumatic events described as interpersonal trauma are complex in nature, due to emotional involvement with people, usually close family members, who were passively or actively involved in the traumatic experience.
Complex trauma is the term used to describe the complicated and pervasive developmental and long term consequences of interpersonal victimisation of children involving multiple events and exposure of an extended duration. (Cook et.al., 2005; Coutois, 2008; Luxenburg, Spinazzola and van der Kolk 2001) It describes the dual problem of children’s exposure to traumatic events and the impact of this exposure on immediate and long-term outcomes. Complex trauma outcomes refer to the range of clinical symptomatology that appears after such exposures.
Therefore, trauma needs to be thought of as a continuum of many factors.
The four questions to ask with the trauma continuum are:
1. What trauma happened to the child? 2. What trauma symptoms are they presenting? 3. What is their current environment like? How safe or stressed are they? 4. What was their first 5 years like?
Parenting capacity is an essential partner to the trauma continuum to highlight the importance of context in the trauma experience.
Four Major Categories of Childhood Trauma Symptoms include (James, 1989):
- Persistent fear state marked by primitive survival responses such as fight-flight-freeze.
- Disorder of memory and trauma related memory disorganization with flashbacks (intense memory recollection) and dissociation (sudden alteration in the integrative function of consciousness)
- Dysregulation of affect and the inability to modulate intense emotions
- Avoidance of intimacy and aversion to physical and emotional closeness that leads to feelings of vulnerability.
James, B. (1989). Treating traumatised children. Glencoe, IL: The Free Press
At the TRC we work with Type I, II and III trauma and we specialise in complex trauma. We offer training in attachment and emotional literacy in educational settings and home settings, we also deliver training on trauma symptom understanding and treatment. We also deliver regular training on trauma, dissociation and complex trauma responses.
Common misunderstanding when working with trauma that can create additional traumatic experiences for children:
- Practitioners can be trained in an understanding of attachment and emotional literacy and believe that this information is sufficient for understanding children with challenging behaviour. We believe that complex trauma needs to be acknowledged as a reality for many children not coping in mainstream schools and that this requires specialist intervention from experienced mental health professionals.
- Those working with children can believe that a ‘therapeutic approach’ is enough for traumatised children and can be unwilling to acknowledge that the years of training and learning that enables a psychotherapist or psychologist or creative therapist to understand children from a neuro-scientific perspective is not needed. ‘Therapeutic’ does not replace or compare with professional therapy.
- Those working with traumatised children need an awareness of the counter productivity of short term interventions such as 6 weeks of one hour sessions of mentoring or therapy; or 12 weeks of support; or visiting an orphanage for a week; or other ST experiences where the children will experience the building of an attachment which is then ruptured. This leads to the children experiencing increased confusion and anxiety about relationships and therefore increases the complexity of their coping mechanisms.
The TRC Complex Trauma team work with a specific TRC Complex Trauma framework which is based on the work of Nijenhuis, E.R.S.; Van der Hart, O. & Steele, K. (2004), and Perry. B. (1999); Silberg. J. (2012) & Weiland. S. (2011).
Recommended literature regarding trauma and our approach:
Teaching the Child on the Trauma Continuum. By Betsy de Thierry, Founding Director TRC
Bill McKitterick, the former director of social care Bristol says:
“This excellent book explains the continuum of trauma clearly in all its complexity in succinct and straightforward terms, drawing on the latest thinking and research in neuroscience. It shows how teachers, while not specialist mental health professionals, can provide skilled and effective help within school and the classroom to children and young people for them to recover from trauma. It recognises the pressure on teachers and schools to meet national educational objectives which can all too easily ignore the particular history and personal needs of individual pupils. The knowledge and skills within this book will enable the busiest teachers to both recognise and to effectively respond to these particular needs, and of equal importance to develop their own skills in reflection and shared learning.”
The Simple Guide To Child Trauma. Betsy de Thierry. Jessica Kingsley Publishers. (2016)
This is often a bestseller on Amazon and is a bestseller with the publishing company. It is a book written expecially to help the adults around the trauma tried child understand trauma, the impact of trauma and how to help a child recover. Many organisations have bought the book in bulk including foster agencies, schools, SEND teams, schools etc.
A great introduction to neuroscience
Complex trauma overview
Play therapy as vital for trauma recovery
Regulation regarding therapy provision for sexual abuse victims going through the CPS
Child Sexual Abuse Fact Sheet