Disorganized attachment is also statistically significant predictor of dissociative symptoms by age 19 and diagnoses of Borderline Personality Disorder and Dissociative Identity Disorder (Lyons - Ruth, 2001)

The Trauma Mechanism

Other mental health problems (Co-morbidity)

e.g. Major Depressive Disorder 48% Physiological response Behavioural re-enactment Developmental impact (Mal)adaptive coping strategies Belief system Trauma

Behavioural Re-enactment

Young people can expose themselves, seemingly compulsively, to situations reminiscent of the original trauma. In behavioural re-enactment of the trauma the characters may play the role of: victim/perpetrator/rescuer.

Three key ways: Harm to Others; Self-destructiveness; Re-victimization. Children seem more vulnerable than adults to compulsive behavioural repetition and loss of conscious memory of the trauma.

Key Concepts

Behaviour is seen as being related to either Hyper-arousal or Hypo-arousal - related to either attachment and / or trauma disorders (Cross, 2005)

Based on sound neurological research about the impact of trauma, attachment and neglect. The use of social milieu and the therapeutic residential care staffs interactions with the child can help regulate the child behaviour (symptoms of trauma)

No child who has experienced trauma is going to heal and learn to use different ways of coping without first feeling secure. For children who have experienced chronic trauma, the importance of environmental interventions can not be overemphasised and is viewed as essential (Shirar, 1996, p 146), in terms of providing the stable and safe place from which therapeutic work can be undertaken (milieu e.g. understanding of parallel processes etc throughout organisation).

Example of structures to help (must be done for all elements of trauma mechanism - hyperarousal etc ):

• Strategies for Traumatic Re-enactment
• Children and Young people:
• Redirection of Traumatic Scenario
• Life Space Interview (provide opportunity to develop insight)
• Safety Planning
• Trauma Work
• Staff & Program:
• Staff Training
• Debriefing
• Focus on Self Awareness
• Theory into Practice
• Hyper-arousal (aggression, impulsive behaviour, children viewed as high risk, emotional and behavioural problems - Fight or flight. response)
• Window Of Tolerance
• Hypo-arousal (dissociation, depression, self harm etc)

If the Child Is Experiencing High Arousal we need to show Low Arousal - Common sense that can be difficult in practise A non-confrontational way of managing challenging behaviour A philosophy of care which is based on valuing people an approach that specifically attempts to avoid aversive interventions. An approach that requires staff to focus on their own responses and behaviour and not just locate the problem in the person with the label A collection of strategies that are designed to rapidly reduce aggression

Share