The 24 / 7 Approach To Improving Outcomes For Children When Working With Chronic Trauma And Dissociation

First published in SJRCC Journal Aug/Sept 2006

‘All truth passes through three stages. First, it is ridiculed. Second, it’s violently opposed. Third, it’s accepted as self - evident’.(Schopenhauer, 2006)

Introduction

In 2004, a report was published by the Scottish Executive on the mental health of young people in residential care in Scotland (Meltzer et al, 2004) Among the report’s findings were the following:

• 45% were assessed as having a mental disorder
• 38% had clinically significant conduct disorders
• 16% were assessed as having emotional disorders – anxiety and depression
• 10% were rated as hyperactive

Some of these mental health indicators are symptoms relating to chronic trauma and dissociative disorders (Terr, 1991; Putman, 1993).

For many centuries various theorists and clinicians have postulated that the mental health of our children which is carried into adulthood if undetected can be in some circumstances can be directly attributed to early childhood experiences of neglect and trauma.

This notion and sense of truth could be viewed as going through a process of being ridiculed and violently opposed, but recently there appears to have been a tidal change. In that society is more able overcome the defensive reactions to such notions to begin to develop appropriate support and services for survivors e.g. Scottish National Strategy for Survivors of sexual abuse.

Chronic traumatisation relates to the recurrent exposure to major stressors over time, such as child abuse. Evidence now strongly supports that chronic traumatisation increases the risk of trauma related disorders of which dissociative disorders are some.

Researchers are now beginning to postulated (Hart et al, 2006) that dissociation is the key concept to understanding traumatisation. As a concept dissociation is a very much misunderstood and at times inappropriately used concept.

Dissociation was initially referred to as a division of the personality or consciousness (Janet, 1887) in which it involved divisions among “systems of ideas and functions that constitute personality” (Janet, 1907, p.332).

It has been described by Briere (1992) as a disruption in the normally occurring connection between feelings, thoughts, behaviours and memories in response to trauma, to reduce the psychological distress both during and after the traumatic event.

Given the high numbers of children and young people in residential care who may be affected by these issues, it is important to examine ways in which they can be approached. This paper discusses a therapeutic model (C.A.R.E) for working with children and young people who have experienced chronic trauma and dissociative disorders.

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