Working with trauma

The contribution of trauma awareness

In the past decade or two, there has been a growing appreciation of the significance of psychological and emotional trauma, building on a growing body of evidence from both neuroscience and clinical (ie: psychological and psychodynamic treatment) practice.

The ‘trauma lens’ helps see the issues  of 'behaviour that challenges' in a new light; to see through the behaviour to the person, and to better appreciate the struggles some individuals face; and especially to avoid replication in the way our interventions may help or hinder.

Probably the majority of staff of support services – like many members of the general public – will recognise all these issues at some quite intuitive level, not through theoretical knowledge, but through general empathy.


Valuing an intuitive understanding of truama

To appreciate the significance of trauma, we do not actually need all staff to be ‘barefoot neuroscientists’, tutored in the bio-chemistry of stress, or the neuro-anatomy of emotional abuse. It is sufficient to be confident that there IS a sound scientific foundation for the empathy that we find we need.

Nevertheless it is more valuable still to be aware of some specific expressions of traumatised experience in subsequent behavioural difficulties. The video we have here is very useful; as is another item we include here, 'How Common Trauma Reactions may explain some 'difficult' behaviours within homelessness services' -  which is an extract from the 'Shelter from the Storm' paper of 2010.

In the PIEs 2.0 formulation, we can put trauma awareness within the category of psychological models that may be very helpful, at whatever level of understanding is needed; and because this may operate at any level in a service, from the receptionist to the clinician, we have made ‘psychological awareness’, rather than any specific psychological ‘model’, the bedrock of a PIE for TIC.

Although we will then want to consider the whole environment of the service, not just the awareness of staff, we can find in 'trauma informed care', and trauma-informed design,  some of the approaches that can be most useful.


Extended empathy

Nevertheless, an understanding of trauma is by no means the only psychological awareness that we need to be able to bring to bear, in work with those with complex needs.  We will also encounter shame; wounded pride, and fragile independence; distrust and anger; despair, and a fear of hope; also courage and resilience; not infrequently, a sense of humour; and even something like grace.

Plus in services now we also need to factor in an understanding of the effects of street drugs; and of the emotional demands of de-tox. But there can be many reasons for chronically avoidant reactions to offers of ‘help’, from ‘cold cluster’ personality disorder to autism to actual past adverse experiences of homelessness or other services.

These are primarily individual experiences; but we must also be mindful of the prevailing mindset of the communities in which we live. Traumatised peole are often having to manage not just their own emotions and reactions, but also the stigmatising, marginalising or excluding reactions of other people.

There is now a growing concern that more unequal societies are frequently marked by harsher, less compassionate attitudes to those that fail; and some suspicion that those who ‘fall through the net’ may then be more inclined to self-blame (see Richard Wilkinson's Pathways conference keynote presentation, in the recommended viewing).


Traumatised services?

Even within supportive services, under current funding  approaches we may see a preoccupation with eligibility criteria, and in consequence a focus on the identifiable weaknesses of any individual. Defensive, 'us and them' attitudes are easily institutionalised; and research that tells us 'what works' elsewhere can often lead to an attitude that we are the experts, which can contribute to selective listening, and further dis-empowering.

But social scientists have argued that we must understand the difficulties for staff working as ‘street level bureaucrats’, managing day-to-day the ambivalence and outright contradictions in society’s expectations as to what they are to do. Meanwhile, within services, the dynamics of inter- and intra-team conflict seem to operate at a level that is quite independent of any initial disturbance; and need to be understood in their own right.

Both the funding of services for quick and simple, one-size-fits-all outcomes, the fondness of political leaders for simple 'evidence-based' solutions, and the 'shock and awe' approach of inspection and regulation regimes may all have contributed to this inflexibility in recent years.

Yet still we will find that many services manage all these issues with an often intuitive sensitivity – without which, in any case, no theoretical knowledge will help. It is from such services that we have distilled the essential features, that we describe as a PIE.

NB: For a discussion of how trauma and TIC fits into the PIEs approach and the PIEs 2.0 framewor, please see 'TIC and PIEs - what's the difference? ' - the page on this site that discusses the divergent history and the recent inter-twining of these two models : HERE.




Further background reading, listening and viewing

'Trauma in human experience: a masterclass' (A different take on the intelligibility of traumatised reactions, from Robin Johnson)


Spot the difference? TIC and PIEs (PIElink competition) : HERE


PIElink pages

Psychological awareness 101 : HERE

Trauma Informed Care : HERE

Trauma-informed design (Q&A) : HERE


A trauma awareness video from Public Health Scotland


Library items

See especially:

Three models of the causes of homelessness, and their implications for the psychology in homelessness services (immediately below)


TIC in the US

How Common Trauma Reactions may explain some 'difficult' behaviours within homelessness services : HERE

Shelter from the Storm : HERE


Rigidity and harshness

Richard Wilkinson’s Pathways conference presentation :  HERE

Wikipedia summary of Lipsky's 'street bureaucrats' : HERE

A whole New world: commissioning for complexity : HERE

Beyond outcomes : HERE

Enabling Help : HERE

Do 'complex needs' need 'complex needs services ? Parts 1&2 : HERE and HERE

Conducting research in a person-centred way : HERE


Other emotions

Meeting the needs of detached young runaways through PIEs : HERE

Avoidance PF in New York research HERE

Autism and homelessness - a briefing for frontline staff : HERE

Executive Functions after Traumatic Brain Injury : HERE

Avoidance strategies stress appraisal and coping in hostels : HERE

Common trust and personal safety issues in homelessness : HERE

The relational nature of hope; and 'scaffolding' (audio) : HERE: