Working with trauma

The importance of empathy

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. 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.

Traumatised services?

Even within supportive services, we may see a pre-occupation with eligibility criteria, and 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 rfegimes may 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.

 

The contribution of trauma awareness

Probably the majority of staff of support services – like many members of the general public – will recognise all these issues at some level, not through theoretical knowledge, but through general empathy; and for this reason, we have made ‘psychological awareness’, rather than any specific psychological ‘model’, the bedrock of a PIE.

Nevertheless, 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 even all these other issues in a new light; to see through the challenging behaviour to better appreciate the struggles some individuals face; and especially to avoid replication.

To appreciate the significance of trauma, we do not 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.

Hence in the PIEs 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 when we want to consider the whole environment of the service, not just the awareness of staff, we can find 'trauma informed care' under the approaches that can be most useful.

 

 

 

Further background reading, listening and viewing

See especially:

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

PIElink pages

Psychological awareness 101 : HERE

Trauma Informed Care : HERE

 

Library items

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

Meeting the needs of detached young runaways through PIEs : HERE

Richard Wilkinson’s Pathways conference keynote presentation :  HERE

Wikipedia on Lipsky's 'street bureaucrats' : 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

Conducting research in a person-centred way : HERE

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