Childress: Trauma Requires Team Work

I’m not from forensic psychology. I’m from the world of trauma pathology – all kinds of trauma, but particularly attachment trauma.

In the world of trauma – van der Kolk, Briere, Perry, Courtois – there is a foundational understanding that treatment of trauma involves a team. When we worked with a child in the foster care system, it was through a team.

Trauma benefits from a treatment team approach.

One of the problems with the current court-involved forensic psychology approach is that each mental health person’s involvement is individual. That’s not trauma-informed practice.

Trauma response benefits significantly from a surrounding trauma team, not just individuals, supporting recovery.

In forensic psychology, their assessments are not being coherently integrated into their treatments, and treatments across providers are not being coordinated around a single diagnostic understanding and treatment plan. Services are fragmented and mental health professionals act alone and each in isolation.

That’s not the proper approach with trauma pathology. For one thing, working with trauma pathology is stressful on the professional, called vicarious trauma, so a team approach benefits the professional in supporting a healthy response to the emotional involvement and vicarious trauma of the provider.

In addition, however, trauma presents with “extreme” symptoms – extreme anger, extreme depression, extreme anxiety, extreme conflict – and chaotic high-demand situations to manage. An individual provider approach is often overwhelmed by the severity and chaotic extent of the trauma pathology, which is why trauma teams develop to coordinate different aspects of treatment and recovery.

For example, the child in our childhood trauma clinic would see an individual therapist at the clinic while the parent or foster parent saw a collateral therapist. There might be additional occupational therapy with a clinic-involved OT, and speech and language services may be involved. In a perfect world we also a had a trauma nurse from the local medical center to do home visits and provide support for the parents, foster parents, and child.

Dialectic Behavior Therapy (DBT), the standard of practice for treating borderline personality pathology, is also structured around a team approach. Borderline personality pathology is a trauma pathology and is moving toward reclassification in the DSM diagnostic system as a trauma pathology. Trauma response and therapy benefits from a team approach.

Moving forward with solutions, we will be constructing a team model surrounding families struggling with divorce transitions. We will begin with trauma-informed skill development for the parents (including the skill of mindfulness), and conflict resolution skills, and then move step-by-step up the level of integrated intervention until the family is able to make a successful transition to a healthy post-divorce separated family structure.

It is always in the child’s best interests for the family to make a successful transition to a healthy separated family structure following divorce. So that’s what we must achieve.

We want to intervene as early as possible with low-level yet effective support, and then increase the levels of support as needed for the severity of the trauma issues in the family.

At all levels of this process, the mental health and legal professionals have to work as a team to respond to the trauma factors in the family, and to work as a team in successfully supporting the family’s transition to a healthy separated family structure following divorce.

For AB-PA pathology, I would recommend the court appointment of an amicus attorney and trauma informed family therapist team – not a GAL – not a minor’s counsel… especially not minor’s counsel, that’s essentially appointing legal counsel for the pathology.

The involved mental health professionals also need to work as a team. And in this team I would include family support and parenting coaches.

Cloe Madanes, a top family systems therapist, published a book in 2018 for coaches and therapists regarding family interventions. A collaboration of coaching with professional psychology is abundantly helpful, especially and particularly with trauma pathology, and a family coaching collaboration with professional family therapy would represent trauma informed practice at its best. This is the collaborative professional support we are building for this trauma pathology.

In most cases, individual child therapists are not needed and therapy can be coordinated and handled by a trauma informed family therapist working with a family and parenting support coach. That should be enough in almost all cases. When both parents are pathological, individual child therapy may be warranted.

Family therapy should rely on established constructs – Bowen, Minuchin, Haley, Madanes, Satir – and be guided by outcome measures like the Parent-Child Relationship Rating Scale.

Parent-Child Relationship Rating Scale

Trauma informed therapy should be solution focused:

Solution Focused Therapy

Trauma tries to drag us back to the past to solve problems that can never be solved… because they are in the past and the past is gone and can’t be changed. Solutions must come from now and from moving forward – not from trying, hopelessly, to fix past problems.

Solution focused family therapy should center around documentation of child symptoms used to help clarify family roles and expectations, and for treatment planning and decision-making. Always the goal is getting more love to the child, we want 100 mom-love and 100 dad-love going to and being received by all children everywhere.

We never-ever want zero mom-love or zero dad-love reaching the child. That is a very bad emotional, psychological, and developmental thing for the child.

We have all had mothers and fathers. We should all remember from our own childhoods how incredibly important mom-love and dad-love was for us and is for a child. If you don’t remember how profoundly important mom-love and dad-love is for a child, that means you have trauma history in your parent-child background growing up, and perhaps you shouldn’t work with this population of families until your own family of origin issues have been thoroughly resolved.

The solution for trauma pathology is through a team approach. That is what we are constructing.

None of this is Dr. Childress or Dorcy Pruter, it is you. It is you, the attorneys, mental health professionals, and parents… it is you who will be constructing the solution. Dorcy and I provide support tools to help you.

The core of a trauma informed team for court-involved attachment pathology surrounding divorce is a trauma informed and solution-focused family therapist who is teamed with an trauma trauma informed amicus attorney, and a family coach. Perfect.

The approach to therapy and recovery of the authentic child and the stabilization of a healthy separated family structure is structured and systemic, and is guided by ongoing collection of symptom data reflecting family functioning. Treatment plans are written and coherent to the pathology, and treatment decision making is data-driven by documentation of symptoms.

Trauma informed practice is centered around a collaborating professional team.

Craig Childress Psy.D.

Clinical Psychologist, PSY 18857

Author: GreatCosmicMothersUnited

I have joined with many parents affected with the surreal , yet accepted issue of child abuse via Pathogenic Parenting / Domestic abuse. As a survivor of Domestic Abuse, denial abounded that 3 sons were not affected. In my desire to be family to those who have found me lacking . As a survivor of psychiatric abuse, therapist who abused also and toxic prescribed medications took me to hell on earth with few moments of heaven. I will share my life, my experiences and my studies and research.. I will talk to small circles and I will council ; as targeted parents , grandparents , aunts , uncles etc. , are denied contact with a child for reasons that serve the abuser ...further abusing the child. I grasp the trauma and I have looked at the lost connection to a higher power.. I grasp when one is accustomed to privilege, equality can feel like discrimination.. Shame and affluence silences a lot of facts , truths that have been labeled "negative". It is about liberation of the soul from projections of a alienator , and abuser ..

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