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Treatment of Complex Trauma and Trauma Informed Care and Service Delivery Perinatal Mental Health Seminar Dr. Cathy Kezelman ©ASCA 2014 ©ASCA 2014.

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Presentation on theme: "Treatment of Complex Trauma and Trauma Informed Care and Service Delivery Perinatal Mental Health Seminar Dr. Cathy Kezelman ©ASCA 2014 ©ASCA 2014."— Presentation transcript:

1 Treatment of Complex Trauma and Trauma Informed Care and Service Delivery Perinatal Mental Health Seminar Dr. Cathy Kezelman ©ASCA 2014 ©ASCA 2014

2 “Failure to acknowledge the reality of trauma and abuse in the lives of children, and the long-term impact this can have in the lives of adults, is one of the most significant clinical and moral deficits of current mental health approaches. Trauma survivors still experience stigma and discrimination and un-empathic systems of care. Clinicians and mental health workers need to be well informed about the current understanding of trauma and trauma-informed interventions” Professor Louise Newman

3 The Last Frontier: Practice Guidelines for Treatment of Complex Trauma & Trauma Informed Care and Service Delivery Launched by Federal Minister for Mental Health (October 2012) Endorsed by national and international experts Download or purchase at

4 Complex: Interpersonal Inescapable Repeated Cumulative Single: Unexpected event - natural disaster, traumatic accident, terrorist attack or single episode of assault, abuse or witnessing of it = PTSD

5 Emotional Neglect Physical Neglect Mother treated violently Contact sexual abuse Incarcerated household member One or no parents Recurrent emotional abuse Recurrent physical abuse An alcohol and/or drug abuser in the household Family member chronically depressed, mentally ill, institutionalized, or suicidal Individual Family Community Intergenerational Ten Categories are from the Adverse Childhood Experiences (ACE) Study

6 ACE Study: Childhood trauma powerfully impacts mental and physical health ‘a half-century’ later (Felitti, Anda et al, 1998) Initially protective (and often creative) strategies to deal with childhood adversity lose protective function over time and threaten emotional AND physical health in adulthood (Felitti, Anda et al, 1998) Avoidance People pleasing Numbing Self harming Controlling

7 ACE Score Percent depressed (%)

8 ACE Score Percent attempted (%)

9 Ever addicted to drugs Ever had a drug problem Ever injected drugs

10 (1) has negative effects across the life-cycle for those who directly experience it (1) intergenerational impacts on the children of parents whose trauma histories are unresolved (Hesse, Main et al, in Solomon & Siegel, 2003) ‘Emotional abuse, loss of caregivers, inconsistency, chronic misattunement principal contributors to psychiatric problems’ (Dozier, Stovall, & Albus, 1999; Pianta, Egeland, & Adam, 1996; van der Kolk, ibid)

11 Impairs wide range of functioning Erodes health and wellbeing Disrupts neural integration Coping mechanisms affect quality of life High alert - easily triggered -> cannot `move on’

12 deep feelings of insecurity; low self-esteem poor frustration tolerance; sensitivity to criticism hyper (physical or psychological agitation) or hypo- aroused (shut down – emotionally numb) substance abuse, self-harming, suicidal, risk-taking behaviours

13 Anxiety; depression; health problems (emotional and physical); disconnection and shame; isolation; confusion; being `spaced out’; fear of intimacy and new experiences Lifetime patterns of fear and lack of trust; long-term difficulties with emotional regulation/ stress; chronic feelings of helplessness; affects relationships with self, others, the world

14 Conditions conducive to development of self- regulation (beginning with a sense of safety) are crucial to adult survivors of childhood trauma In contrast to the traumatized person who has experienced a sense of safety and well-being prior to onset of the (single-incident) trauma, the survivor of complex trauma does not start with this advantage (Shapiro, 2010)

15 The possibility of underlying trauma (ie even not disclosed) requires immediate attunement to: attachment issues the possibility of dissociation `Contact itself is the feared element because it brings a promise of love, safety & comfort that cannot be fulfilled & that reminds [the client] of the abrupt breaches of infancy ’ (Hedges, 1997:114; ibid).

16 People often show a `mix’ of `hyper’ (visibly agitated) and `hypo’ (emotionally `shut down’) responses rather than being `either-or’ KEY POINTS: Both HYPER & HYPO arousal responses can be trauma- related Failure to understand this leads to inappropriate responses by health professionals

17 Don’t underestimate capacity of positive interactions to be soothing and validating Positive relational experiences promote wellbeing - actively assist healing Prior experience of person is difficult – not person This applies to us all - especially important for people with trauma histories

18 Current systems inadequate Applicable to full spectrum of human services delivery Minimises re-traumatisation Recognises many conditions are trauma-related (Perry, 2008; Ross and Halpern, 2009) Awareness of impacts ‘Do no harm’ approach Cultural safety Staff training New Paradigm ahead

19 Safety Trustworthiness Choice Collaboration Empowerment

20 Commits to and acts upon the core principles Requires evaluation of all components of the system Design service systems that ‘accommodate the vulnerabilities of trauma survivors’ (Fallot and Harris, 2009:3) Delivered in a way that will ‘avoid inadvertent re- traumatisation and...facilitate client participation in the services which affect them’ (Fallot and Harris, 2009:3)

21 Trauma as a defining and organising experience that forms the core of an individual’s identity rather than a single discrete event (Jennings, 2004; Fallot and Harris, 2009) Understanding client behaviours as adaptive attempts to cope ‘What happened to the person rather’ than ‘what is wrong with the person’ (Bloom, 2011; FallotandHarris, 2009) Emphasis on skill building

22 Stress experienced by staff negatively impacts clients Staff sensitivities can be ignited in interactions with clients, particularly if staff themselves have unresolved trauma histories Vicarious trauma (VT) is the `negative transformation in the helper’ from exposure to traumatic material in the context of a helping relationship (Pearlman & Caringi, 2009) Stress breeds stress and attentiveness to wellbeing is the antidote

23 Professional support line Operates 9am-5pm Monday - Sunday EST Education and training workshops Resources Factsheets, guidelines, newsletters Advocacy and health promotion Contact: Dr. Cathy Kezelman


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