APPLYING TRAUMA-INFORMED PRINCIPLES TO SOCIAL WORK PRACTICE

APPLYING TRAUMA-INFORMED PRINCIPLES TO SOCIAL WORK PRACTICE

By recognizing the possible existence of a trau- matic history, we can make it a priority to establish physically and psychologically safe therapeutic en- vironments. Early trauma (especially familial abuse) often breeds a sense of wariness and a mistrust of caregivers and authority figures. A salient need for clients, therefore, is to encounter environments and relationships that challenge their expectations of the world as an unsafe place in which relation- ships are fraught with danger and disappointment. Safe relationships are consistent, predictable, and nonshaming. Social workers should model respectful interpersonal boundaries, language, and use of power so that safe and appropriate limits can be set without recreating the oppressive actions of others

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that featured prominently in the lives of many clients (Bloom & Farragher, 2013; Harris & Fallot, 2001).

For example, when a client did not like an answer he was given, he became combative and then stood up to storm out the door, saying, “I need to leave before I do something I regret.” Instead of confronting or chastising the client, the social worker responded, “I can see that you are upset, and I appreciate that you want to control your temper. Let’s take some deep breaths together, and talk about what’s making you so mad right now.” After he calmed down, the social worker kindly observed, “I bet I’m not the first person to tell you that you can be a little scary when you’re mad.” The client laughed and agreed that his mother and girlfriend tell him that all the time. This opened a conversation about how his anger can sometimes be used to intimidate others into acquiescing to his desires, that this was similar to what he observed in his father growing up, and how better conflict resolution skills might reduce his tendency to violate the boundaries of others in this way.

Motivational interviewing (Miller & Rollnick, 2012) is commonly used with a variety of at-risk populations by infusing cognitive–behavioral ther- apies with humanistic principles to adopt a more client-centered approach. People who engage in addictive, self-destructive, or victimizing behaviors may be judged by social workers as disturbed or unstable; with these clients it can be easy to over- look a history of trauma and attribute their be- havior to an unrelated cause, such as bad moral character or lack of motivation for change. When social workers view clients as being defective, we tend to intervene paternalistically and exacerbate the very problems that would be better addressed through TIC (Levenson, 2014). Instead, we should validate the mixed feelings and inner conflicts about change that naturally emerge in counseling, emphasize strengths, and help clients identify and reduce barriers to personal growth.

When practitioners fail to respond in a validating or empathic manner to resistant, antagonistic, or hostile clients, a negative interaction occurs, ob- structing client engagement and producing a rup- ture in the therapeutic alliance (Binder & Strupp, 1997; Teyber & McClure, 2000). When clients display resistance, clinicians in all disciplines some- times respond in ways that seem rejecting, judg- mental, or disapproving (Binder & Strupp, 1997). Social workers may be especially susceptible to

this detrimental process with nonvoluntary clients, because these individuals may enter mandated in- tervention programs with defensiveness or denial. Binder and Strupp (1997) cautioned that negative process is a contributor to treatment failures in all psychotherapy modalities serving a range of client populations. Indeed, those with the most off-putting behavior may be most in need of trauma-informed responses. Social workers should reflect on the ways that their own beliefs, values, attitudes, and experi- ences might hamper their engagement style and unwittingly reproduce disempowering dynamics in the helping relationship (Levenson, 2014).

Gender-specific services are also important, as women have specific empowerment needs that reflect the link between poverty, violence, andmental health symptoms (Covington & Bloom, 2007; East & Roll, 2015; Elliott et al., 2005; Topitzes, Mersky, & Reynolds, 2011). Men with childhood abuse histories also require relevant interventions (Easton, Coohey, Rhodes, & Moorthy, 2013; Levenson et al., 2016). For instance, responses to family dysfunction may manifest in different ways: Teenage boys may gravi- tate toward gangs or delinquency for a sense of con- nection and inclusion, and teenage girls may be prone to early pregnancy if they long for someone to love them. These problems are better viewed as symptoms of underlying trauma, and TIC interven- tions include simply interacting with clients in ways that convey that they are special, important, and valuable.

It is not uncommon for social services clients to present with a history of poor self-regulatory capaci- ties. Households that lacked modeling of effective emotional and behavioral management often rein- force maladaptive coping methods that provided an antidote to anxiety or internal distress. When emo- tional dysregulation and flawed cognitive schema are well rehearsed in the context of coping with chronic toxic stress, they can become deeply en- trenched in personality traits (Bloom & Farragher, 2013). Traumatic reenactment occurs in the social services setting when negative clinician responses contribute to self-fulfilling prophecies of failure, which in turn fortify anxiety and reinforce inflexible coping, thus dissuading clients from help seeking. For example, responding to a client who is consis- tently late to group therapy sessions with a critical reminder about rules and consequences for tardiness can reproduce shame and fear. Instead, the social worker might remember that this client grew up in

110 Social Work Volume 62, Number 2 April 2017

a home with parents who were hoarders and who provided no modeling of routine, structure, order, or scheduling; the client had learned that disengage- ment from peers was a way to avoid the embarrass- ment of her household. The social worker might acknowledge the client’s discomfort of being in a group of people and can then help the client process her avoidant tendencies, check the bus schedule, plan what time to leave the house, and further develop and refine skills of time management. Some clients need social workers to provide a mentoring role that their parents lacked, and to alter expectations accordingly.

As a result of early experiences of oppression, marginalization, discrimination, or child mistreat- ment, social services clients often display an as- sortment of relational problems that stem from long-standing core schema about themselves and others (Teyber & McClure, 2011; Young et al., 2003). These thematic beliefs underlie interper- sonal skill deficits and associated behaviors, and can generate a repetitive cycle of maladaptive distress-relieving strategies and problematic rela- tional patterns. The helping relationship offers an opportunity for intervention when the professional responds to the vulnerability activating the negative interaction instead of directly challenging the behav- ior itself (Teyber & McClure, 2011; Young et al., 2003). For instance, a client became angry when asked to change to a different group session. “I like this group! I don’t want to start over with others!” Instead of pulling rank and forcing the switch, the social worker responded, “You make a good point. You are reminding me that your feeling of connec- tion with members in this group is more important than my need to assign you elsewhere.” When the client continued the rant, the social worker observed, “Your expectation that others won’t respect your wishes seems to be causing you to talk louder, which means that you haven’t been able to hear me agree with you.” This led to a great conversation about the anxiety and escalating agitation that are triggered when feeling disrespected by others.

SUMMARYAND CONCLUSIONS Trauma-informed social work can be integrated into all sorts of existing models of evidence-based services, but TIC can strengthen the therapeutic alliance and facilitate posttraumatic growth. In all settings, engaging clients with compassion and

respect is the crucial factor in enabling change, regardless of the intervention, but practices must also be culturally relevant and consider the social context of racial, economic, and gender disparities (East & Roll, 2015). Engagement difficulties can be mitigated by recognizing and addressing the legacy of complex trauma, and this is likely to enrich intervention effects.

Social workers who are familiar with the perva- siveness of early adversity and the damaging impact of these experiences on presenting problems across the life span will be able to deliver services in a more trauma-informed fashion. The research liter- ature indicates that a warm, interested, and vali- dating therapeutic alliance is more influential in facilitating positive therapy outcomes than theoret- ical framework, professional discipline, or specific counseling techniques (Duncan, Miller, Wampold, & Hubble, 2010; Thomlison, 1984; Wampold, 2001). A nonthreatening service delivery environment will facilitate trust, emotional safety, and intimacy.

TIC should be conspicuously embedded in all social work settings, from a public or nonprofit agency to a private practice. Social workers in clin- ical, case management, or advocacy roles can all infuse TIC principles into their understanding of, and interactions with, clients by conceptualizing problematic behavior as a by-product of posttrau- matic stress (Levenson, 2014). The accumulation of negative experiences in childhood can trigger enduring neurodevelopmental changes, but neu- roplasticity allows the brain to integrate new ex- periences that pave the way for emotional healing and develop new neural pathways to behavioral and cognitive change (Anda et al., 2006; van der Kolk, 2006; Weiss & Wagner, 1998). When social workers incorporate trauma-informed practices, they enable emotionally curative experiences that permit new skills to be cultivated, rehearsed, and reinforced. SW

REFERENCES American Psychiatric Association. (2013).Diagnostic and sta-

tistical manual of mental disorders (5th ed.). Arlington, VA: Author.

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