The Trauma Experts Voices
In our journey as adopters in crisis, we are not alone. Alongside us walk trauma experts, who have not only worked with us but have stood by us, sharing our frustrations and lending their support. They wish to be heard also to ensure that the central issues plaguing adoption crisis – the oversight of childhood trauma and the misconception that love within a forever family is sufficient for healing. Their expertise reinforces what we, as adopters, have come to understand firsthand: that love, though undoubtedly vital, is not a remedy for the deep-seated wounds borne of early-life adversity.
PATCH QUESTION TIME
Answer provided by Wild Ways Therapy
Do you believe early life trauma/ adverse childhood experiences impact on a child’s functioning and development, and impact on later life outcomes?
Yes, Felitti et al’s study (published 1998) evidences well the chronic negative impact of Adverse Childhood Experiences (ACEs) on life outcomes. It is important to note that the 10 ACEs put forward for this study did not include separation at birth/maternal loss or prenatal exposure to alcohol or toxins. It also did not include living outside of the birth family, e.g. being ‘care-experienced’ or issues surrounding attachment trauma. It didn’t include (as it was prior to, for e.g. the UK Equalities Act) a person identifying as having any protected characteristics and the socio-political effects of living as a marginalised/minoritised person in any way. This is important to note as many adoptive children/young people have identities which intersect across protected characteristics, Increasing their vulnerability.
What are some of the issues that may arise from a child who has experienced early life trauma?
This is a very complex and nuanced question. Here is a brief list:
Developmental delay
Learning needs
Attachment needs (delayed and regressive behaviour)
Interpersonal/relational challenges
Mental Health needs
Problems with emotional regulation
Dysregulated nervous system
Sensory processing needs
These can all present as activated behaviours, both hyper and hypo in nature ‘misbehaviour’ and also ‘overly compliant and suggestible’ leading to highly increased vulnerability. Hyper and hypo behaviours are all signs of distress.
If a child is provided with positive safe care, is this enough for the trauma to heal on its own?
Early life trauma happens across the child’s whole system – emotionally, psychologically, and physiologically. So where stability in the home and positive, safe, predictable and sustained parental attunement is crucial, it is important to note that reparative, therapeutic interventions will be essential, with support from professionals – to include the caregiving system around the child, school and ongoing support into adulthood.
If a child has experienced early life trauma, what is the best approach to help them heal, succeed emotionally, and thrive in life?
I advocate for systemic support that helps primary parents/carers provide sustained, attuned, resilient, present, responsive love and care. Sounds good yes?! But what does that mean for the parents/carers. Parenting a child with trauma in their background can mean managing a lot of uncertainty, highly challenging behaviours, relentless needs and compounding stressors from the education (social/health) systems. What a child needs to heal and thrive is an ‘unassailable safe base’ (Sarah Naish NATP) that withstands all of the above and is able to keep repeating, meeting the need, supporting attachment reinforcement and therapeutically parenting every behaviour to help new behaviours to embed and for a secure attachment to be built over time. Children need well resourced, well supported, well trained, rested, believed and respected parents/carers.
What is the best way to help a family in crisis/ and or what do you feel could be done better?
A bespoke family centered therapeutic plan to include interventions such as: therapy for the child/young person eg DDP, Filial therapy, Theraplay. Sensory Assessment, additional educational Psychological assessment and IEP/EHCP to support mental/social/relational health in school.
Bespoke support for the parents/carers. Identifying individual needs of parent(s) and meeting them eg respite, personal psychotherapy – including trauma therapy to process any events the parent/carer has experienced as a result of parenting their child(ren). E.g. many parents disclose witnessing/experiencing risk taking behaviours in their child/young person such as self-harm, suicide attempt, child on parent abuse – verbal, physical, coercive control, financial. These can lead to not only compassion fatigue, burnout, secondary stress but, for some, PTSD in the parent(s). PTSD must be identified and treated as part of a holistic approach to the whole family need. Processing their traumatic experiences enables parents to maintain their relationship with the child(ren)/young person and can support the reduction of chances of family breakdown/disruption.
Adopters are experiencing shame and blame for not managing complex family issues. What do you think the cause of this is?
Lack of trauma-informed and trauma-enhanced, trauma- specialist (Scottish Psychological Trauma Framework) professional settings (eg Education/Social/Health Services) can contribute to a lack of professional awareness and training in the presentation of complex themes such as Developmental trauma, FASD, CPA, Attachment trauma etc.
Framing a child/young person’s dysregulated and activated behaviours and a parent’s inability to manage these complex, relentless and often frightening behaviours as being rooted in poor parenting is a reductionist view. Where parents/carers can, of course, benefit from additional training in therapeutic parenting etc., it ignores the fact that prolonged exposure to extreme stress in the home (often over decades) will be impacting that parent and their ability to stay in attuned and ‘present’ relationship with their child, especially during highly dysregulated periods. This is not a parenting flaw but a natural, psychologically protective state that can emerge in the face of extreme stress, violence and chaos. Blaming the parent for behaviours arising from e.g. Developmental Trauma and/or FASD ignores the etiology of the conditions and further impacts (harms) the capacity (esteem and mental health) of the parent/carer, the child’s greatest ally/advocate.
Family breakdown, adoption crisis, disruption is said to be on the increase, why do you think this is?
I think it is the perfect storm of there being more children in crisis with their mental health in general (particularly since the pandemic), and more children in the care system with much more complex (trauma based) needs being adopted – meeting cuts in services, especially CAMHS.
Demand is outstripping capacity at an alarming rate leaving families without support, meaning behaviours and needs escalate. With 2 year waiting lists for CAMHS for young people who are self-harming and evidencing Suicidal Ideation, families are in significant, chronic and compounding distress.
When considering the journey of parenting children who have experienced significant adversity and trauma, what is best placed to support parents/ carers to navigate this?
Training and in the case of adoption, preparation that includes individual psychological support and processing of their own history. Developing emotional regulation skills and understanding our own (unique) strengths and vulnerabilities is very impactful and ameliorative. Also having good resources and pathways highlighted in case of need so the parent/carer can reach out when first in need, rather than delaying seeking support, eg preventative practice over compounding practice by the professional system supporting the family.
There appears to be a propensity for professionals to believe allegations made by children.
Children who have been through trauma are often known to have a pattern of being dishonest and un-factual. Professionals react to the allegation which has led to some significantly damaging outcomes for parents – leaving the family home, being arrested, suspension from work. Leaving a massive impact on parent’s mental health and wellbeing.
Do you think there is a way of dealing with allegations in these circumstances which is more appropriate for all?
Working with a Multidisciplinary Team (MDT) that have training in confabulation, traumatic memory, triangulation and attachment seeking themes would benefit professionals in holding a trauma-informed lens in cases of allegation. Whilst holding safeguarding at the centre of all allegations, the complexity of eg. confabulation and suggestibility where developmental trauma and FASD are present (suspected) and the research emerging in this area means that cases such as these will need a sophisticated, nuanced and specially trained team of professionals to oversee the allegation. Given that at least one case of suicide by a foster carer who was falsely accused, there is a professional imperative to do so.
Social workers are the professionals working adoption crisis, breakdown disruption. What are your views on this?
There are brilliant social workers and social work teams who work with great integrity. I believe an MDT approach can enhance this complex and sensitive area. Including other professionals from education and health services and other therapy professionals can bring an enhanced lens to the family’s need and offer novel, bespoke interventions on a case by case basis. Eg. OT sensory processing assessments can be really helpful. Respite and enhanced educational input (EHCP, SEND and Residential provision) can offer the break that some families need. Ongoing 1:1 therapy for parents/carers and the child (and any other children affected) post disruption is essential.
If a parent is suffering from secondary trauma, survival mode (and possibly more) what is the best way to support them?
Secondary trauma can be treated with therapy with a specialist, trained therapist. Being in a survival loop can lead to burnout. Both secondary trauma and burnout can escalate, if not supported, into a chronic trauma response such as PTSD. Seeking a therapist who is trained/experienced in the background is very important. Eg a therapist who is trained in adoption themes, developmental trauma, Child on Parent Abuse (CPA) etc.
It is imoprtant to remember that for some parent/carers the trauma is not ‘secondary’. If, for example, the parent/carer has been the victim of violence from their child then this is a primary trauma source which can lead to PTSD. Parents/carers often minimise the effect of CPA on them. Being hit/hurt, having things thrown at you, intimidation and chronic, pervasive control due to threat of escalating behaviours can be traumatising.
What skills/ learning/ knowledge should an effective practitioner have when working with families in is?
Scope. No one practitioner should be trained in everything. Working with your strengths and what you enjoy is important because this is professionally sustaining and supports job satisfaction. Knowing what you ‘don’t’ know and where your scope ends means you can build networks of professionals you can refer to, liaise with and work with in an integrative way with the best outcomes for your clients being upheld. I reference the Scottish, Transforming Psychological Trauma Framework is an excellent framework that offers a professional pathway for organisations to identify individual scope, triage and refer on where appropriate. Eg. On this framework, I identify as a Trauma-Specialist (Integrative) Psychotherapist and as such am qualified to provide services to those with clinical need, including PTSD. https://transformingpsychologicaltrauma.scot/media/5lvh0lsu/trauma-training-plan-final.pdf