Mea Culpa: I have ignored my clients’ trauma experiences

For over 10 years, I have been a practicing clinical social worker actively working with adolescents & adults in behavioral health settings. In those 10 years, I avoided my clients’ trauma experiences through either omission or deflection. I felt I did not have the training to treat such a potentially difficult issue. I was afraid of re-traumatizing my clients.

In the past 6 months, I have begun to understand trauma, especially the role of complex trauma on my clients’ development. I now educate my clients how trauma affects their emotions, cognitive processes and ability to connect to others. I have started a process of screening all clients at my clinic for trauma and launched an evidence based trauma program, Cognitive Processing Therapy, to serve the needs of our traumatized clients. I have moved my long-term clients into phase II of DBT treatment to address PTSD and trauma experiences directly.

I now know that trauma informed care means all the changes I have made in the last 6 months but it also means simply an increased sensitivity “to the ways in which the client’s current difficulties can be understood in the context of past trauma” (Knight, 2014, p. 25). Knight notes, trauma-informed social work practice seeks to validate and normalize the client’s experiences, with an emphasis on “helping survivors understand how their past influences the present and on empowering them to manage their present lives more effectively, using core skills of social work practice” (p. 25). This is the crux of the worldview shift I have experienced in the last 6 months–I am capable of providing the support and understanding my clients need to address their past trauma and to empower them to continue to improve their lives, despite their past.

I have also become a follower of the Anda & Felitti’s (1998) CDC sponsored ACE’s Study. I now understand that the popular conception of PTSD and its DSM defined cluster of symptoms is a narrow interpretation of the experiences of people with complex trauma. In my practice, I more often see complex trauma, which includes childhood abuse and neglect compounded by life-threatening traumatic experiences as adults.

The traumatic stress field has adopted the term “Complex Trauma” to describe the experience of multiple and/or chronic and prolonged, developmentally adverse traumatic events, most often of an interpersonal nature (e.g., sexual or physical abuse, war, community violence) and early-life onset. These exposures often occur within the child’s caregiving system and include physical, emotional, and educational neglect and child maltreatment beginning in early childhood.— Bessel A. van der Kolk

Understanding complex trauma, its effect on development and how traditional treatments (medication, talk therapy) fail to address it, is an issue of critical consciousness raising. As I gain a clearer understanding, I share it with my clients and students. Together, we are empowered to create new paths to healing from trauma. Ultimately, we are also called to address prevention. If child abuse and neglect is the basis for the majority of our society’s ills (substance use disorders, health disparities, the school-to-prison pipeline…), then as an advocate of social justice I must work to end it.

NPR’s All Things Considered recently reported on the ACE study. See it here:
http://www.npr.org/blogs/health/2015/03/02/377569413/can-family-secrets-make-you-sick
http://www.npr.org/blogs/health/2015/03/02/387007941/take-the-ace-quiz-and-learn-what-it-does-and-doesnt-mean

References

Bessel A van der Kolk. (2005). Developmental trauma disorder. Psychiatric Annals, 35(5), 401.
Cunningham, M. (2003). Impact of trauma work on social work clinicians: Empirical findings. Social Work, 48(4), 451-459. doi:10.1093/sw/48.4.451
Felitti, V., Anda, R., Nordernberg, D., Willimason, D., Spitz, A., Edwards, V…. and Marks, J. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245-258.
Goelitz, A., & Stewart-Kahn, A. (2013). From trauma to healing: A social worker’s guide to working with survivors. Hoboken: Taylor and Francis.
James, K., & Breckenridge, J. (2010). Educating social work students in multifaceted interventions for trauma. Social Work Education, 29(3), 259-275. doi:10.1080/02615470902912250
Knight, C. (2015). Trauma-informed social work practice: Practice considerations and challenges. Clinical Social Work Journal, 43(1), 25-37. doi:10.1007/s10615-014-0481-6
Strand, V. C., Abramovitz, R., Layne, C. M., Robinson, H., & Way, I. (2014). Meeting the critical need for trauma education in social work: A problem-based learning approach. Journal of Social Work Education, 50(1), 120.
Zubrzycki, J., Nelson, D., & Price, E. (2014). Integrating human rights and trauma frameworks in social work with people from refugee backgrounds. Australian Social Work, 67(4), 567-581. doi:10.1080/0312407X.2013.777968

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