Tymur Hussein – Therapeutic Family Model of Care

27/03/2015
Centre of Knowledge
Recovery from Relational Wounds:
Attachment and Trauma Informed Practice
Tymur Hussein
tymurh@lighthousefoundation.org.au
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
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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).
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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
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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
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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
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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
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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
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