Understanding Complex Trauma

Children and young people in the “looked-after” sector are frequently dealing with issues related to complex trauma.

This needs to be understood and held by those seeking to work therapeutically with the children and young people, and in working with the adults who care for them.

These young people will almost inevitably be dealing with separation issues, having been removed from their initial primary carers; in many cases, they may have several moves of placement before finally reaching a permanent, healthy, effective home. Indeed, there is a not insignificant number who continue “bouncing” through the system until they reach adulthood.

Owing to these breaks in attachment, trust is often a major difficulty, influencing therapeutic work.

One thing that rapidly becomes clear when working with complex trauma in looked-after young people is the need for long-term, consistent care and therapeutic intervention. There is no such thing as a quick fix.  This is described well by Bruce Perry in “The Boy Who Was Raised as  Dog”:  “The brain changes in response to patterned, repetitive experiences: the more you repeat something, the more engrained it becomes. This means that, because it takes time to accumulate repetitions, recovery takes time and patience is called for as these repetitions continue” (p.245)

Looked after children and young people will often have been removed from unhealthy, traumatising environments, and need to experience a new, therapeutic environment in order to change the way their brains work. They often come into the new environment knowing how to manage the world: adults are not to be trusted; I am worthless; attachment leads to abandonment; to survive, I have to depend on myself; I must be in control; etc.  This can often lead to difficulties within the new placement, if the carers are not given high levels of training and support in creating a “healing” environment. The therapist can have a major role in helping the carers to understand why the child needs to behave in the way he or she does.

The American psychologist and author, Dan Hughes, talks eloquently about the need for the (foster and adopted) parents and the therapist to hold what he calls the “therapeutic attitude” – one of playfulness, acceptance, curiosity and empathy (the PACE model). I have seen this work very successfully in foster placements I have had the privilege to support over the years. It is vital to remember that working therapeutically with these damaged children does not include working punitively. Punishment does not help the traumatised child. Bruce Perry again: “Traumatized children tend to have overactive stress responses and …. these can make them aggressive, impulsive and needy … Only patient, loving, consistent care works …. Just because a child is older does not mean a punitive approach is more appropriate or effective” (p.244)

Unfortunately, we live in somewhat of a blame culture. Rather than blame the traumatised child for turning out exactly as we have made him or her, we need to recognise the need to change the environment around him or her.  I have yet to meet the child who chose which womb to grow in, or who chose how he or she was going to be parented. The child’s brain adapts to the environment in which it grows and develops. If we wish to change how the child thinks, feels or operates, then we need to change the environment around him or her; new, healthy brain wiring requires new, healthy data. This is the task of therapy and care.

The child in the care system carries what I believe to be one of the most difficult disabilities a child can have.