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Arnon Bentovim - Episteme

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The impact of Trauma on Attachment –<br />

Trauma Organised Systems and<br />

Traumatic Attachments<br />

Promoting the recovery of children exposed to a<br />

climate of family violence and adversity-<br />

A life span trauma narrative approach<br />

Systems of Trauma<br />

Systemic interventions in post –traumatic situations<br />

Turin 2007<br />

<strong>Arnon</strong> <strong>Bentovim</strong><br />

www/childandfamilytraining.org.uk<br />

bentovim@lcfcs.co.uk


Growing up in a climate of abuse and<br />

violence<br />

Sebastian Faulks - Engleby(2006)<br />

• ‘That child would slowly ascend towards full<br />

awareness in a world whose sky was violence and<br />

whose horizons were fear. And however resourceful<br />

he was, however patient and fortunate in the events<br />

of his life which followed, he was like a creature in a<br />

nest of imprisoning boxes who could never really<br />

break free’<br />

• ‘This was his world and any attempt to persuade him<br />

that it was merely a ‘subjective’ or ‘individual’<br />

experience would never convince him’


Goals for the presentation<br />

• 1 Current research on the impact of living in a<br />

climate of violence, abuse and neglect on children<br />

• 2. Approaches to assessing and intervening on the<br />

impact of these events on children young people and<br />

carers<br />

• 3. Approaches which are helpful to create a<br />

transformative narrative of traumatic and stressful<br />

events over the life-span of the child<br />

• 4. Approaches to promote recovery and growth<br />

• 5. Acknowledgements


U.S. Perspective of the Impact of Trauma on<br />

Development<br />

(Harris, Lieberman and Marans JCPP 2007)<br />

• ‘Each year exposure to violent trauma takes its<br />

toll on the development of children<br />

• Children are at increasing risk of school failure,<br />

anxiety, depression and PTSD; alcohol and drug<br />

abuse; the perpetration of the violence to which<br />

they were exposed<br />

• ‘Troubled children’ in education system, child<br />

protection, law enforcement, substance abuse,<br />

criminal justice<br />

• The root of their problem – exposure to violence<br />

and and abuse is unrecognised


NSPCC study on Prevalence of abusive<br />

experiences in childhood<br />

• Serious physical abuse and violence causing physical injury,<br />

7%<br />

• Serious absence of physical care carrying a high risk of<br />

injury 6%<br />

• Serious absence of supervision allowed to stay out<br />

overnight under 10, parents not knowing whereabouts under 14,<br />

5%<br />

• Serious emotional,control,domination,humiliation<br />

withdrawing affection 6%<br />

• Sexual abuse, all forms 12 and under 16%<br />

• Sexual abuse, contact abuse 11%


Poly-victimisation: A neglected<br />

component in child victimisation<br />

(Finlelhor, Ormrod and Turner 2007 CAN)<br />

• National representative sample of of children’s experiences<br />

of violence and the mental health consequences, 2- 17<br />

• Juvenile Violence Questionnaire, sexual victimisation,<br />

physical assault, property victimisation, maltreatment, peer/sib<br />

victimisation, witnessing<br />

• 22% experienced 4 different types of victimisation in<br />

previous year, high (7) 7%, lower (4-6) 15%<br />

• Adversity factors relevant, and co-occuring in rape,<br />

witnessing assault, dating violence<br />

• Higher the number of victim experiences the more<br />

extensive the mental health effects, and the less specific<br />

the effects


The impact of living in a climate of violence –<br />

the development of sexually abusive behaviour<br />

(BMJ. 317, 175-179 1998)<br />

SIGNIFICANT FACTORS<br />

• Experiencing<br />

intrafamilial violence<br />

• Witnessing family<br />

violence<br />

• Rejection by family<br />

• Discontinuity of care<br />

Recurrent acts of<br />

physical abuse<br />

Recurrent exposure to<br />

marital violence or sibling<br />

abuse<br />

Rejection by emotional<br />

abuse or neglect<br />

Marital breakdown, in care,<br />

Children’s home, foster care<br />

18.0<br />

8.1<br />

7.5<br />

7.2


Models to understand the family as a<br />

violence prone institution<br />

• Cumulative models the numbers of biological, family and<br />

environmental stressors rather than particular combination<br />

• Biosocial model –the interactional and cumulative effects of<br />

biological and environmental adversity<br />

• Eco-systemic models- looks at the way family and<br />

environmental stressors affect parenting and the impact on how<br />

children's needs are met<br />

• Trauma-organised systems organising the realities of<br />

relationships


Impact of traumatic experiences on brain<br />

development (Glaser)<br />

• Experience determines pattern of brain development,<br />

• Brain development mirrors experience<br />

• Effect of serious deprivation causes most harm by<br />

o early experiences incorporated into neural networks<br />

o The effects of stress on brain development<br />

• Established connections not erasable but new learning<br />

(synapses) possible<br />

• Patterns often enduring, children experience threat despite<br />

protection, hyper-vigilant, hyper-aroused dissociation is a<br />

form of flight<br />

• Secure attachment is protective of stress response


Impact of traumatic experiences on<br />

development – dynamic narratives<br />

• Attachment trauma life-span impact of cumulative adversity<br />

• failure of mentalisation –the loss of a capacity to symbolise mental<br />

states –understand one’s own and others thinking or feeling<br />

• Fails to distinguish between internal and external reality<br />

• Dissociated from reality- loss of memory – false self/reality<br />

formation<br />

• Traumatic bonding –disorganised attachments –clinging to abusive<br />

parents –<br />

• Identification with the abuser –the perspective of the malevolent<br />

other- an alien being in the self representation


Family Violence –Trauma Organised<br />

Systems<br />

Systemic narratives<br />

• Trauma-Organised Systems are action systems<br />

• The “victimiser” is overwhelmed by impulses to<br />

actions of a physically,sexually ,or emotionally<br />

abusive nature,which emerge from his<br />

experiences.They are felt to be”beyond control”<br />

• The cause is attributed to the “victim”who in<br />

line with individual,familial and cultural<br />

narratives, is construed as responsible for the<br />

victimisers feelings and intentions.<br />

• Potential protectors are neutralised,organised by<br />

a process of minimisation,deletion and denial


Growing up resilient in a climate of<br />

violence and abuse<br />

Child abuse and neglect volume 31, no3 march 2007<br />

edited by Cathy Widom<br />

• Stressful factors and effects accumulate in<br />

particular families<br />

• Consequences accumulate in strength over time<br />

• A sub-set of individuals are resilient in adolescence,<br />

young adulthood and into later life ‘turning points’ can<br />

occur<br />

• Bright and sociable evoke support from teachers<br />

and children, fosters positive adaptation, the child going<br />

from strength to strength<br />

• Modifying behaviours consequent to abuse launches<br />

positive trajectories.<br />

• Multisystemic interventions minimise family and<br />

neighbourhood stressors, foster children’s innate<br />

personal resources overcomes impact of adversity


Clinical contexts where exposure to a<br />

climate of violence is characteristic<br />

• Children of parents with mental health, marital<br />

violence and substance abuse<br />

• Looked after children in foster and residential care<br />

• Later adopted children and young people<br />

• Young people responsible for seriously offending<br />

behaviour, secure placements<br />

• Young people in in-patient care<br />

• Children and young people taking a caring role<br />

with parents with disability and mental health<br />

problems


Establishing a context of work<br />

• Role of parents, foster carers, adoptive parents,<br />

residential workers and therapists taking a<br />

collaborative role<br />

• Therapeutic elements include<br />

- Establishing a context of adequate care<br />

-Trauma focussed therapeutic approaches<br />

- Narrative approaches<br />

-Systemic solution focussed approaches<br />

-The creative use of approaches


Stages of Therapeutic Work in Constructing a<br />

transformative life-span trauma narrative<br />

• First stage –Providing protection and constructing a<br />

professional narrative<br />

• Second stage – engaging the child or young person<br />

in therapeutic work<br />

• Third stage – Finding a language to engage in<br />

exploring emotional responses associated with<br />

traumatic life events<br />

• Fourth stage – Creating a narrative account of<br />

traumatic life events<br />

• Fifth Stage - Promoting recovery and a future<br />

resilient life


First Stage –<br />

Providing protection and constructing a<br />

professional narrative and profile of<br />

harmful impacts


Assessment Framework<br />

A map of relevant data to be collected<br />

Identity<br />

Family & Social<br />

Relationships<br />

Social Presentation<br />

Selfcare Skills<br />

Education<br />

Emotional &<br />

Behavioural Development<br />

Health<br />

CHILD’S DEVELOPMENTAL NEEDS<br />

CHILD<br />

Safeguarding<br />

CHILD<br />

Safeguarding &<br />

promoting &<br />

promoting welfare<br />

welfare<br />

Basic Care<br />

PARENTING CAPACITY<br />

Ensuring Safety<br />

FAMILY & ENVIRONMENTAL FACTORS<br />

Emotional Warmth<br />

Stimulation<br />

Guidance &<br />

Boundaries<br />

Stability<br />

Housing<br />

Income<br />

Community<br />

Resources<br />

Family’s Social<br />

Integration<br />

Employment<br />

Wider Family<br />

Family History<br />

& Functioning


Harm to Healthy<br />

Development Neglect,<br />

Failure to Thrive<br />

Parental Difficulties & Harmful<br />

Impacts on Development<br />

Insecurity,<br />

accidental & non<br />

accidental<br />

injuries, physical<br />

& sexual abuse<br />

Difficulties<br />

in providing<br />

protection &<br />

security<br />

Difficulties in<br />

provision of care &<br />

attention to health<br />

needs<br />

Negative<br />

family &<br />

environmental<br />

factors<br />

Difficulties in<br />

providing<br />

stimulation &<br />

communication<br />

Harm to<br />

psychological &<br />

educational<br />

development<br />

potential<br />

Harm to<br />

emotional<br />

development<br />

& emotional<br />

functioning<br />

Difficulties in<br />

providing consistent<br />

emotional warmth<br />

and responsiveness<br />

Difficulties in<br />

providing guidance,<br />

boundaries &<br />

management of<br />

behaviour<br />

Difficulties in<br />

providing stable<br />

relationships<br />

Harm to Identity<br />

Formation &<br />

Capacity for<br />

making<br />

relationships<br />

<strong>Arnon</strong> <strong>Bentovim</strong><br />

Harm to capacity to<br />

develop collaborative<br />

& prosocial behaviour


Gary<br />

THE WARDS<br />

Moira<br />

Ian<br />

14yrs<br />

8yrs<br />

Laura<br />

Michael


WARD FAMILY - Family Assessment<br />

• Former period of satisfactory care. Moira’s previous violent<br />

partners, alcohol used as a coping strategy.<br />

• Ian’s family use violence as means of control<br />

• Ian and Laura forceful, conflictual, Moira and Michael<br />

tentative, overwhelmed<br />

• Michael withdrawn sad and needy, Laura supports Michael,<br />

Moira organised by Ian’s forceful adversarial views, feels<br />

conflicted by her commitment to Ian and the pull of the<br />

children, Laura asserts family values<br />

• Michaels needs not met, Moira drinking heavily, Laura absents<br />

herself, risk of violence between the couple and towards<br />

children<br />

• Secure attachments have been disrupted by Moira’s<br />

accommodation to Ian who demands self-sufficiency, is punitive<br />

and critical, triggering Moira’s drinking


infantile/pseudomature<br />

Insecure,<br />

disorganised or<br />

indiscriminate<br />

attachments,<br />

/controlling angry,<br />

dismissive<br />

responses<br />

Unresponsive,<br />

unreliable,<br />

fragmented care<br />

giving<br />

Inaprop.<br />

expectations<br />

dependence/<br />

independenc<br />

e<br />

Failure to<br />

provide<br />

security and<br />

protection<br />

from harm<br />

Failure to provide security<br />

and protection from harm<br />

inappropriate<br />

punitiveness or<br />

sexual,<br />

experiences<br />

Evidence of<br />

physical or sexual<br />

abuse, sexualised<br />

behaviour,<br />

frozen/arousal<br />

responses<br />

Evidence of harmful<br />

exposure<br />

exposure to risky<br />

individuals inside<br />

and outside the<br />

home<br />

Unsafe<br />

environment,<br />

physical hazards<br />

inside outside the<br />

home<br />

injuries,<br />

continuing<br />

unprotected<br />

risks<br />

<strong>Arnon</strong> <strong>Bentovim</strong>


Pervasive<br />

negative mood<br />

and self<br />

perception,<br />

affective<br />

disorders,<br />

aggressive<br />

oppositional<br />

responses<br />

Lack of emotional<br />

responsiveness, or<br />

regulation of<br />

emotional states<br />

frozen, arousal state,<br />

anger, fear, clinging<br />

avoidance<br />

negative<br />

emotional<br />

tone,<br />

exploits,<br />

disqualifies<br />

lack of<br />

support<br />

Failure to express or<br />

respond to feelings,<br />

critical, humiliating<br />

rejection. ignoring<br />

Failure to<br />

provide<br />

adequate<br />

emotional<br />

warmth and<br />

protection<br />

Traumatic losses<br />

and traumatic<br />

stressful events,<br />

Failure to provide adequate emotional<br />

warmth and responsiveness<br />

Failure of<br />

empathic,<br />

emotional<br />

understanding,<br />

parental emotional<br />

states, distorted<br />

perceptions<br />

mental health,<br />

relationship<br />

conflict, substance<br />

abuse<br />

Lack of empathy,<br />

unfeeling,<br />

aggressive,<br />

withdrawn,<br />

distancing,<br />

Persistent fear,<br />

distress, anxiety,<br />

anger,,<br />

regression,<br />

caretaking<br />

responses,<br />

organised by<br />

parental reality<br />

<strong>Arnon</strong> <strong>Bentovim</strong><br />

Persistent grief and<br />

unresolved traumatic<br />

symptoms,<br />

dissociated states,


Steps to determine risks of re-abuse, and<br />

prospects for rehabilitation (1)<br />

• Overall levels of harm<br />

• Level of protection parenting and therapeutic work<br />

required<br />

• Acknowledgement of harm, responsibility taken, and<br />

need for intervention<br />

• Acknowledgement of level of parenting difficulties<br />

• Motivation to achieve change<br />

• Potential to respond to child’s needs within time<br />

frame


Steps to determine risks of re-abuse and<br />

potential for rehabilitation<br />

• Influence of Individual and Relationship factors<br />

• Acknowledgement of role and potential for change<br />

within child’s time frame<br />

• Recognition of role of environmental factors and<br />

potential to change<br />

• Role of family professional relationships


Overall Process of work<br />

Initial intervention<br />

Therapeutic work in a context of protection<br />

Work with Perpetrators and Protective parents<br />

The use of different intervention approaches<br />

Rehabilitation phase of work


Developing<br />

secure<br />

attachments,<br />

confidence &<br />

freedom from<br />

harm<br />

Developing<br />

adequate<br />

emotional coping<br />

skills & resilience<br />

Providing<br />

responsive<br />

care, safety<br />

& protection<br />

Providing<br />

emotional warmth<br />

and responsiveness<br />

Developing<br />

healthily &<br />

good self care,<br />

thriving<br />

Provision of<br />

basic care &<br />

attention to<br />

health<br />

Positive family<br />

&<br />

environmental<br />

factors<br />

Providing adequate<br />

boundaries &<br />

managing behaviour<br />

Providing<br />

adequate<br />

stimulation &<br />

communication<br />

Providing stable<br />

& consistent<br />

family<br />

relationships<br />

Parental Strengths & Impacts<br />

on Child Development<br />

Developing<br />

skills &<br />

educational<br />

capacities &<br />

potential<br />

Developing a sense<br />

of identity, social &<br />

family relating<br />

<strong>Arnon</strong> <strong>Bentovim</strong><br />

Developing<br />

collaborative &<br />

prosocial behaviour


•1996 you were born<br />

•1998 2 years<br />

•1999 3 years old<br />

•2000 4 years old<br />

•2001 5 years old<br />

•2002 6 years old<br />

•2003/2004 7/8 years<br />

Charlotte’s Life- Experiences<br />

•You lived on an estate<br />

•Your brother was born<br />

•Your sister was born<br />

•Your Dad, Mum and your brother and sister<br />

moved around all over the country. Dad got<br />

violent to your uncle when you were staying<br />

with him. The police arrested him. Mum was<br />

scared and left, she was too scared of dad to<br />

take you, she had a handicap<br />

•Dad was arrested for being drunk, he<br />

argued with your aunt and left with you and<br />

your sibs, he had a lot of trouble with anger<br />

•You all moved to another house with dad’s<br />

friends who used drugs, You went on<br />

moving, living in pubs and homeless<br />

accommodation<br />

•Dad had a gun, dad was drinking a lot, you<br />

were filthy<br />

•You were living in a mess, not being fed or<br />

looked after, not going to school<br />

•After a lot of concerns by social workers<br />

you are taken into care, your dad is in prison<br />

for hitting someone badly


Charlotte’s Initial State, aged 8<br />

• Health-Poor growth, neglected appearance, persistent UTI<br />

• Education – Continuing restlessness ,aimless, boredom, poor<br />

basic skills, major gaps requires significant remedial help,<br />

• Emotion –Indiscriminate, insecure disorganised Phases of<br />

extreme emotional distress, pervasive negative mood,<br />

intolerance of frustration, anger, arousal and oppositional<br />

behaviour. No capacity to think about others ’<br />

• Post-traumatic nightmares, flash-backs, re-experiencing is<br />

less


Charlotte’s initial state<br />

• Identity-Has to be a compulsive carer, wants to clean, do<br />

housework. Feels close to her father, preoccupied with him, is<br />

angry she is not with him. Very poor sense of herself, rejects<br />

foster carer<br />

• Relationships-Has no capacity to confide in her foster-carers,<br />

longs to see her siblings, fighting and rivalrous with foster sibs,<br />

• Social relationships- squabbling and unable to make<br />

friendships<br />

• Self presentation Ashamed of her appearance ,felt dirty,<br />

compulsively washing<br />

• Self care Has lapses, forgets to wash, wets soils, infantile<br />

capacities


Second Stage<br />

Working with Children<br />

•Establishing the child’s life-line and<br />

experiences


Therapeutic Approaches<br />

•Establishing a working<br />

relationship and alliance –<br />

building up an attachment –<br />

individual, group and family<br />

contexts<br />

•Working with protective parents,<br />

carers of creating a ‘therapeutic<br />

team’ who witness both the<br />

impact of trauma and its<br />

overcoming<br />

•Awareness of attachment style<br />

•Fosters acceptance, collaborative<br />

consistent, reliable, safe, calm<br />

•Fosters cohesion, belonging and<br />

boundaries, clarify confused<br />

perceptions<br />

•Fosters sharing pleasure, pain,<br />

successes<br />

•Reframe, positively connote<br />

behaviour, and externalises<br />

problems –’ the spoiler’<br />

•Seek exceptions, solutions,<br />

survivor scripts


How do I tell my story?


Other methods used<br />

•Geno-gram<br />

•Psychotherapeutic board games<br />

•Video – in relation to Anger<br />

management<br />

•Building bricks – used as an analogy for<br />

‘coping strategies’<br />

•Video player – Buttons for Play, Pause,<br />

Re-edit, Stop and Eject (help Timothy<br />

to manage his flashbacks)


Pete’s Ecomap<br />

ECOMAP SECTION<br />

0 – 5 years<br />

Mrs<br />

McGavin<br />

Model<br />

Maker<br />

Ian<br />

Pat<br />

Mum<br />

Dad<br />

John<br />

Mrs<br />

Woodhall<br />

YOU<br />

Granddad<br />

Carl<br />

Auntie<br />

Lily<br />

Nan<br />

BO<br />

You are in the centre, there are 2 outer circles, an inner circle to put important people who<br />

are close to you, e.g. family members, and an outer circle to put in people who are not so<br />

close. You can join up the people to yourself with lines to show the bond.


Norman’s Life-Line


Similarities<br />

•Both of us are funny and like cars<br />

•We can both cook and we both swear<br />

Ways to describe Dad<br />

•Workaholic<br />

•Does illegal things<br />

Things I would like to be different:<br />

•That he had treated us nicely<br />

•Me still living with him<br />

•Him not doing illegal things<br />

•Him being there for me when things were<br />

bad<br />

Things I learned from Dad<br />

•How not to treat women<br />

•How to fix cars<br />

•Humour<br />

•Swearing<br />

How can he help me in future?<br />

•With money and bits I need


Similarities<br />

•Both get upset<br />

•Can both cook and draw<br />

•Like the same music and films<br />

Ways to describe Mum<br />

•Kind and caring<br />

•Calm and observant<br />

Things I would like to be different:<br />

•Her picking a decent boyfriend<br />

•Her having some confidence in herself<br />

•That she had stood up for me more when I<br />

was little<br />

Things I learned from Mum<br />

•How to cook<br />

•How to look after myself<br />

•That there are really bad people out there<br />

•Care for others<br />

How can she help me in future?<br />

•Being there if I need someone to talk to


Similarities<br />

•Both funny and a bit silly sometimes<br />

•Can like cars and playing in the park<br />

•Both like fashionable clothing<br />

Ways to describe James<br />

•Funny and friendly<br />

•Annoying and nagging<br />

•Co-operative<br />

Things I learned from & about James<br />

•That I should deal with my feelings better<br />

•That he didn’t like it (sexual abuse)<br />

•That abuse is not a way of getting back at<br />

people<br />

•That he wasn’t responsible<br />

How can I manage my relationship with him in<br />

future?<br />

•Have a meeting with him before I leave<br />

•Not be on my own with him<br />

•Tell people when I’m feeling risky<br />

•Walk away or play football when feeling<br />

annoyed with him


Third Stage –<br />

Exploring the emotional<br />

experiences associated with<br />

traumatic events


Third Stage<br />

Exploring the emotional experiences<br />

associated with traumatic events<br />

• This stage marks the process of exploring<br />

feelings and managing them<br />

• It is vital not to expose painful feelings<br />

without the tools to cope with such feelings,<br />

developing coping skills<br />

• Sharing with carers reinforces the key<br />

witnessing process which has been found to<br />

be the essential ingredient in trauma<br />

therapies


Why am I such a Mess?<br />

I want my mum to write to me – I want a<br />

happy family…. I feel abandoned!<br />

I feel my life is a big mess – I<br />

am in the middle of it and would<br />

like some answers!!!


In my Shoes<br />

The matrix: people, settings<br />

and emotions


The matrix: people, settings<br />

and emotions<br />

people<br />

emotions<br />

settings


Standard Scenes


Rachel’s Scenes<br />

Then the scenes are repeated with a<br />

male child, then with a female child.


Pete’s Emotions Palette


I’m always anxious<br />

coming out of cubicles<br />

when other men are<br />

there. I always get<br />

this feeling that they<br />

watching me.


Structure of the programme:<br />

Somatic experiences<br />

Somatic experiences module<br />

•Representation of pain and discomfort that has been<br />

experienced.<br />

•Pain can be represented by different shapes, sizes and an<br />

indicator of 'throb'.<br />

•A written account of an uncomfortable experience can be<br />

incorporated.


Stuart – unable to talk about domestic<br />

violence<br />

Stuart<br />

• Full care order<br />

• Moderate learning difficulties<br />

• Witnessed and experienced extensive violence in the<br />

home<br />

• Highly anxious<br />

• Soiling and enuresis<br />

• Victim of sexual abuse by older peer at school<br />

• Perpetrator of sexual abuse against younger siblings,<br />

young cousin and another child


Somatic experiences of Stuart 1


Somatic experiences of Stuart 2


Processing Difficult Experiences<br />

Vulnerable<br />

Angry<br />

Very unsafe<br />

Defence Left Fullback Centre Half Right Fullback<br />

Damaging<br />

things<br />

Absconding<br />

Energetic &<br />

Hyper<br />

`<br />

Just give up<br />

There’s noone<br />

to look<br />

after me<br />

I’m alone<br />

No-one cares<br />

L.Midfield Centre Midfield R. Midfield<br />

Secretive Being abusive Not talking or<br />

listening<br />

Centre Forward Strikers


Processing Feelings 2<br />

Contained<br />

Safe<br />

Defence Left Fullback Centre Half Right Fullback<br />

Family<br />

work<br />

I can trust<br />

people<br />

Talking about<br />

my feelings<br />

Adults taking<br />

charge in a<br />

positive way<br />

Midfields L. Midfield Centre Midfield R. Midfield<br />

Stick with<br />

it<br />

More<br />

confident<br />

Taking care<br />

of myself<br />

Stay on<br />

supervision<br />

Centre Forward Strikers<br />

It’s going<br />

to be OK<br />

Happy


Fourth Stage<br />

-Processing difficult experiences<br />

Creating a Narrative of Stressful<br />

and Traumatic events in your life


Creating the Trauma Narrative<br />

Defining the nature of the experience<br />

• We need to go slowly into what happened<br />

in as much detail as possible,.<br />

• use all the skills you've developed to<br />

write, draw and talk even about the most<br />

distressing<br />

• Put yourself back there in your mind, as<br />

if it’s happening, but you’re in control<br />

• We’ll see how you felt throughout, try to<br />

make sense of the way you felt,<br />

• Trauma is like an infection, if it’s left it<br />

can heal, but it can get worse – the bad stuff<br />

has to be let out –


Creating the Trauma Narrative<br />

Promoting recovery –first stages<br />

• To consider how you felt, what explanation did<br />

you give yourself and how do you explain it<br />

now<br />

• .<br />

• Arousal, cutting off, fight and flash-backs are<br />

strengths, but may not be necessary any longer,<br />

and need to be controlled<br />

• Use supportive family members to confirm what<br />

happened<br />

• , Ask questions, get help to confront those who<br />

hurt be prepared to answer questions from<br />

those who you may have hurt


Norman’s Life-Line<br />

• 10.09.91: Norman was born. Lived<br />

with Mum and Dad<br />

• Age 3yrs: Birthday party at<br />

McDonalds. Living in good<br />

neighbourhood.<br />

• Age 5yrs: Moved house and had<br />

first kiss.<br />

• Age 6yrs: First memory of watching<br />

mum and dad row. Went to my<br />

room<br />

5. Rowing more frequent<br />

• Happy<br />

• “Twas goood!”<br />

• “Pissed off! Left it<br />

• Sad & pissed off


• Age 6yrs: Brother Allan born<br />

• Age 6yrs: Dad left home. I<br />

saw him pack his bags and walk<br />

out. I asked mum what was<br />

happening and she told me. It<br />

was both their fault.<br />

• Changed school<br />

• Age 7-8yrs: David moved in<br />

(mum’s new boyfriend). Later<br />

moved house – nice area. Not<br />

much arguing<br />

• Very happy<br />

• Upset, annoyed, angry.<br />

• Bored but I was popular and had<br />

lots of friends<br />

• Happy


• Age 8yrs: Sister Lilly born<br />

• Arguing increased between Mum and<br />

boyfriend. Age 9-10yrs they split<br />

up and he moved out<br />

• Age 11yrs. We moved house and<br />

moved in with ‘an arsehole’ called<br />

Gerry and his daughter (9-10yrs).<br />

Shared a bedroom with Allan. Moved<br />

school. Had no friends.<br />

• Happiest day of my life<br />

• Annoyed, angry, upset<br />

• Felt crap. Couldn’t be asked.


•At this point Norman was finding it increasingly<br />

difficult to talk about his experiences. Instead<br />

he used the life line to communicate. I would ask<br />

him questions and he would write or draw the<br />

answers on the life line


• Age 11yrs: Moved in with<br />

Dad and Carrie (his wife),<br />

James (her son), Allan.<br />

• Age 13yrs: Sexually abused<br />

James<br />

• ANGRY! Because she thinks<br />

she can boss me about.


Fifth Stage<br />

Transforming the Trauma<br />

Narrative<br />

Promoting Recovery –later<br />

stages


Charlottes Trauma Narrative,<br />

the process of recovery and growth<br />

•Then<br />

•I was horrid to mum, we hit her,<br />

spat at her, threw food on the floor,<br />

dad would hit her if she didn’t<br />

make something different. She did<br />

what I told her<br />

•Mum argued with dad, she walked<br />

out on us, dad cared about us, she<br />

did’nt<br />

•We didn’t have to go to school, we<br />

played in the road, dad took us to<br />

loads of places we had a good time<br />

•Dad got into fights, he was at the<br />

pub, we were frightened, we had<br />

to clear up if he was sick, he was<br />

better than mum<br />

•Now<br />

•I'm not like my dad, I look like<br />

him, but I’m soft like mum really, I<br />

don’t have to hit people with bats,<br />

he’s scary, I cant trust him, he<br />

never says sorry, why not?<br />

•I wished I hadn’t been horrid to<br />

mum, it wasn’t right, I’d like to say<br />

sorry<br />

•I wished I went to school. I've<br />

missed out, I’m cross and sad<br />

•The nights were worst, really<br />

frightening, dad started trouble, we<br />

never knew what would happen.<br />

Dad said he’d kill mum if we went<br />

with her, she wanted us,he blamed<br />

her, he hit her all the time, it made<br />

us scared.


Changes noted in Charlotte<br />

1 The evidence for recovery and growth<br />

• She has been in foster care 2 years 8 – 10 years<br />

• Health- Gradual improvement in all areas of functioning,<br />

• Education – Continuing restlessness, boredom,major gaps no<br />

concept of time<br />

• Emotion –extreme emotional distress, anger, arousal and<br />

oppositional behaviour modifying.’<br />

• Miss ‘Temper’ is less in control, Mood is generally more positive<br />

• She is beginning to think about how other people feel, and how<br />

to treat them, mentalising<br />

• Not the punitive parent in therapy, experiences the terror<br />

and fear she was exposed to<br />

• Post-traumatic nightmares, flash-backs, re-experiencing is<br />

less


Changes noted in Charlotte<br />

2. The evidence for recovery and growth<br />

• Identity- Distancing herself from birth family, part of foster<br />

family –mum and dad- not the compulsive carer<br />

• She feels different – something clicked –not now traumatically<br />

bonded to father<br />

• Relationships- Increasing confiding in Foster mother, has<br />

written letters to parents<br />

• Social relationships- still squabbling and losing friends<br />

• Self presentation proud of her hair and appearance, was<br />

ashamed felt dirty, compulsively washing<br />

• Self care –has lapses, forgets to wash


Old me – New me


OLD ME<br />

Smoking<br />

Swearing a lot<br />

Hanging around in gangs<br />

Sexually abusive<br />

Angry<br />

Confused<br />

Scared<br />

Unwanted<br />

NEW ME<br />

Happy relationship<br />

Children<br />

Houses<br />

Cars<br />

Working as football coach<br />

or mechanic<br />

Earning loads of money<br />

Cheerful & happy<br />

Polite<br />

Not being abusive<br />

05/06/06<br />

Angry, scared,<br />

Annoyed, confused.<br />

A bit happy and<br />

Cheerful. Good<br />

Sense of humour<br />

06/08/07<br />

About to leave<br />

SWAAY


Creating a survivor script with Pete: 1<br />

• Pete was fixated on needing<br />

his father to be in prison before<br />

he could move on. This had to<br />

be symbolic of putting him<br />

‘behind bars’.<br />

• We also worked with Pete to<br />

accumulate evidence of when<br />

his positive self had managed to<br />

come though since been at<br />

SWAAY.


Pete’s positive thinking cycle<br />

I can make<br />

and maintain<br />

Healthy<br />

relationships<br />

I am a<br />

Good<br />

person<br />

I am not my<br />

father<br />

I can change<br />

I do not need<br />

To control<br />

others<br />

I can manage<br />

my feelings<br />

I can make<br />

the<br />

Right<br />

choices<br />

I am responsible<br />

For my choices


Creating a survivor script with Pete:<br />

Focusing on the positive present.<br />

What is the most positive you’ve felt in the<br />

last week on a scale from 0-10?<br />

9<br />

What made you feel like that?<br />

Getting a placement at college<br />

How did you feel within yourself?<br />

Speechless


Creating a survivor script with Pete:<br />

Future Life Line<br />

• Next 6months:; start college, see brother, make<br />

friends, and possibly girlfriend.<br />

• 6months-1yr: get on with people, learn how to<br />

handle different types of animals.<br />

• 1Yr: job as pet shop assistant, achieve certificate.<br />

• 1yr 6 months: job, and phone.<br />

• 2yrs: Achieve diploma.<br />

• 5yrs: get a degree, live with mum for a couple of<br />

years, have a girlfriend lots of friends, be able to<br />

drive.


My story as a Survivor and Creating a Good Life<br />

Timothy<br />

I am 14 years old. I have got 4 half siblings, 1 brother<br />

I first was abused when I was 2 years by my Step-dad touching, oral and anal sex. He<br />

forced me to have sex with Brian’s bottom and Tracey’s vagina.<br />

No-one believed me except for my dad and his girlfriend. the police said I was too young to<br />

know .I went into care because of my abusive sexual behaviour towards girls at school.<br />

I went into 2 foster care homes, I was setting fire and having sex with the girls. I went<br />

back to dad’ I was always fighting and getting in trouble with the police.<br />

I stayed for 3 years in foster care I was too bad for them to<br />

handle me. I showed my penis to their granddaughter,. I came to SWAAY.<br />

I was smoking, absconding and getting into fights. I touched 2 boys here.<br />

my Independent Visitor, was sexually abusing me, touching and giving oral sex to him,<br />

I could not talk. I was scared, worried, frustrated And threatened. I was acting my<br />

feelings out<br />

to make adults realise. I finally spoke out I did not want to be a victim any more.


My story as a Survivor and Creating a Good Life<br />

I am Timothy, I am 14 years old and a SURVIVOR<br />

When I was 2 years old I was abused by William.<br />

I was just a child, which makes William responsible for the abuse.<br />

I didn’t know the difference between right and wrong, I thought it was all just a game<br />

William forced me to abuse Brian and Tracey. I am feeling annoyed, frustrated and<br />

confused.<br />

William took my childhood away from me..<br />

I know now what I did to Brian and Tracey was abuse and that it was WRONG.<br />

I have gone into therapy and talked about it. I am doing group work and individual work.<br />

I am doing all of these things to help me be a better man.<br />

I have abused other children. I also know that it was wrong: Because it was under aged.<br />

Because Both parties didn’t agree. Because it was abuse.<br />

My Independent Visitor abused me when I was 14. He was responsible because he is the<br />

ADULT.<br />

I found it hard to speak out because I was scared.<br />

He abused the right to be my Independent Visitor.<br />

I was acting out my feelings. The adults didn’t notice, which left me feeling let down<br />

until I spoke out and not wanting to be a victim any more. I have worked hard by<br />

talking and trying to build my relationships back up with some adults.<br />

I AM A SURVIVOR. MY LIFE IS GOING TO BE DIFFERENT BECAUSE I AM NOT<br />

GOING TO BE<br />

A VICTIM OR AN ABUSER ANY MORE. I WANT A GOOD FUTURE WITH A FAMILY<br />

OF MY OWN.<br />

I WOULD LIKE TO PLAY FOOTBALL OR RUN MY OWN GARAGE.

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