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Dr Sheena Webb, London FDAC team manager and consultant clinical child psychologist
Tom Borro, Social Worker in the Coventry FDAC team
This is the third in a series of blogs about FDAC and the work of the FDAC specialist teams. In this blog we want to talk about trauma and the impact it has on many, if not all, of the parents who come into FDAC.
Working with high risk families, we often hear the term ‘poor choices’. Many of us have experienced the frustration and disappointment when a parent seemingly turns their back on a chance at reunification with their child in favour of drugs, alcohol or a domestically abusive partner. It is hard to see this as anything other than a ‘poor choice’. But what do we mean by ‘choice’? To understand why people make ‘poor choices’, one has to consider what the necessary requisites are for making ‘good choices’.
The word choice indicates that a person is presented with options and has the freedom, will and ability to evaluate these options and select the one most suited to their needs and wishes. Inherent here is the assumption that these choices are viable, and not only that, but that the individual recognises which they are capable of, which are safe and which are more likely to achieve success.
To do this, we need to be shown what good choices look like. Many intervention models focus on the idea that if we educate parents better in what good choices are, they will eventually take a different path. However, for some this is not enough. Why, when given all the information, the support and the access to make better choices, do people still seem unable to follow a safer path? The vast majority of parents coming through FDAC, and care proceedings in general, are missing the basic psychological building blocks needed to make these choices. Frequently they have experienced repeated trauma from an early age, whether that be the horror of sexual or physical abuse, or the terror of seeing domestic abuse or growing up with no safe adult to seek comfort from. The continuous flooding of the mind with fear leads to efforts to shut it down and to the individual being less and less able to access the mental resources they need to make good choices (see Judith Herman, Trauma and Recovery, 2015).
Emotions are our guidance system: we need to be able to detect and interpret our emotional responses accurately in order to protect ourselves. Emotions help us to survive as a species. Emotions tell us what to approach, what to avoid, what is unjust, what is pleasant and what is harmful. When the emotional system has been battered by a childhood full of terror, confusion and betrayal, it becomes erratic, unreliable or sometimes totally shut down. We lose access to the feelings that we need to appropriately guide and motivate our behaviour.
When we give parents choices without understanding the impact of such a childhood, we are expecting parents to make good choices without the tools to do so. FDAC has over the years been developing as a Trauma Informed Service to try and give parents the building blocks they need to make good choices by recognising the damage caused to their emotional system by years of unaddressed trauma. Without giving parents insight into how their trauma affects their behaviour, and offering them tools to tune into their emotions in order to recognise what is safe and what is nourishing, there is always a risk they will continue to make poor choices. This is not about excusing parents’ behaviour by recognising the impact of their past, but about empowering parents to make good choices by helping them understand their past. The more a person understands their past, the less they need to fight with the fear created by it, and the more able they are to engage their minds with the present.FDAC provides a small but potentially very powerful window of time within which to help parents break the unhelpful cycles they have been in for years. But in order for this to be effective, we have not only to identify the fundamental drivers to their behaviours, we have to help them feel safe enough to open up their minds; to feel, think and live in the present. A trauma-informed approach recognises from the outset that the people you are trying to help will struggle to fully engage with services because of the harm caused to them by other people in the past. The guiding principle is ‘Do no harm’. This is hard in the context of care proceedings which are inherently traumatic. However, by putting the impact of repeated trauma front and centre of our thinking, we can make better sense out of the risky behaviours of the people we work with. This not only leads to better understanding, but greater compassion and ultimately more effective treatment. A compassionate approach starts to open a window in these shut down minds, and once the window is open many things are possible that were not possible before.
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In Coventry FDAC we have set up a Seeking Safety group for mothers to help them understand their experiences and struggles with drug and alcohol use through the lens of their trauma. All mothers invited to the group have had or are having difficulties with substance misuse, and have had a child or children removed from their care. This allows the group work to keep in mind the very unique trauma felt by mothers who have had a child removed. In addition all the mothers have experienced some form of trauma either during their childhood, or in the period leading up to the removal of their child.
The group is modelled on Lisa Najavits’s manual Seeking Safety – A Treatment Manual for PTSD and Substance Abuse 2002. Najavits sets out the link between substance abuse and Post Traumatic Stress Disorder and what is appealing about this approach is that it puts in place a joined up method of working with parents across areas that can often feel fragmented when they are seeking support through traditional substance misuse and mental health services. The Seeking Safety group is not a replacement to these services, but a place where different ideas and strategies can be explored, and where trauma and substance misuse underpin the group’s thinking.
Based on her own extensive research and practice experience Najavits developed an evidence based manual for professionals to use in a group work setting. The book contains 25 topics, with a suggested session format for each, as well as the rationale for and objectives of each session. The sessions cover such things as: Asking for Help, Honesty, Setting Boundaries in Relationships, Healthy Relationships, Getting Others to Support Your Recovery, Taking Good Care of Yourself, Coping with Triggers, and similar topics.
In Coventry we follow the sessions closely, but have adapted them so they are more relevant to the mothers we are working with. The group meet once a week for 2 hours and although the sessions all relate to each other they are also designed to be independent which gives us greater flexibility in allowing parents to attend the group from the point when they start working with FDAC rather than waiting for the group to begin at the beginning some months later. The feedback from the parents about the group is very positive and attendance is also good despite the length of the course.
The mothers often say that they feel more comfortable in the Seeking Safety group compared to attending other groups (such as parenting or substance misuse courses) within the community. The mothers say in particular that they feel less judged because all the participants have experienced the loss of a child from their care as well as other traumas. This allows the mothers to feel more open about discussing how their care of their children in the past has not been good enough. The group work encourages the parents to think about the link between their difficulties and trauma, and through the strategies suggested they are able to make sustained changes to their lives. This for the parents is both empowering and also provides them with the practical steps and strategies they can use immediately to imbed the process of change.
One of the particularly nice aspects of the group is the culture of mutual respect and support which emerges between the mothers, each with their own strengths and vulnerabilities. On one occasion a mother spoke about how she was being asked to attend a substance misuse course that she did not want to attend. Another mother said that she had done that course and thought it was brilliant so the reluctant mother went on the course and afterwards was recommending it to others.In Coventry we are now developing a framework for working with fathers that incorporates the elements of the Seeking Safety Group topics and approach.