A Challenge for UCS: The Relevance of Trauma-Centered Care Through the Lifespan
By Alya Reeve, M.D., M.P.H., Medical Director of UCS
The complex and changing world we live in provides many opportunities for experiences we seek out and ones that are thrust upon us. Some experiences are overwhelming, painful, and deeply searing in their lasting effects on our psychological functioning. Such events are described as traumatic. A traumatic event is lived in two ways: by the traumatic experience – how the person perceived and felt during the event, and the traumatic memory – the person’s memory of his or her traumatic experience.
September is dedicated, among other things, to bringing awareness to the prevention of suicide. In this short article I am not addressing the ways we need to work more consistently as a community to prevent suicide, but rather to discuss one of the effective approaches toward prevention of suicide by addressing an important contributing factor for many individuals. Whatever the age, a traumatic event shakes up a person’s sense of order in their life, safety and connectedness with people who are important to them. Sometimes this is for a brief time and the person is able to regroup, find a healthy solution and move on to deal with other challenges of daily life. At other times, the traumatic experience and memory dislodge all equilibrium, cause deep disruptions in interpersonal connectedness, and even lead a person to lose all interest in struggling to stay alive.
A number of clinical staff at UCS working with children have become trained to integrate trauma-informed interventions in their work, such as skills training, relaxation and psychoeducation. With some clients, UCS clinicians are doing trauma-focused work following protocols for reducing the impact of recent traumatic events, such as manualized procedures, eye movement desensitization and reprocessing (EMDR), and trauma-focused cognitive behavioral therapy. A trauma-centered approach starts from the initial interview to explore the foundations of traumatic events, traumatic experiences and traumatic memories. The impact of past traumas on current functioning remains a focus of therapeutic work, but does become the sole focus of the treatment. In this way, it reflects something of a middle road between trauma-informed care and trauma-focused care.
There are three critical reasons why UCS needs to embody a trauma-centered approach. As a scarce resource trying to effectively serve a community that has experienced a lot of psychological, physical and sexual trauma, providing our community with effective tools to prevent the development of persistent traumatic experiences and intrusive and demoralizing traumatic memories is the way to support the greatest health in our clients. Second, developing a consistent approach in giving children with traumatic experiences the tools with which to effectively cope, it is important to continue to provide this therapeutic guidance into and throughout adulthood. In this way UCS can help to break cycles of familial and historical trauma. Third, a commitment to employing a trauma-centered approach means that we will assure that all our staff are trained and competent to provide trauma-informed care and interactions (not just clinicians). In this setting only some professionals will be trained to provide trauma-focused specialty care. Others will know how and when to a referral for specific types of therapeutic work is called for.
From a diagnostic perspective, PTSD (post-traumatic stress disorder) is not the only outcome of experiencing a traumatic event. Many individuals with major depression, somatization disorder, dissociative disorder, eating disorder, substance use disorder, or antisocial, paranoid, or borderline personality disorder will benefit from careful and thorough trauma-centered psychotherapy. In other words, integrating a trauma-centered approach to all clinical interactions and assessments will be relevant to our clinical impact for all people seeking care.
At UCS we can make sure that we have provided necessary information and training to all of our staff. In addition to initial training, this means an ongoing dedication to training and assessment of how well and sensitively we are providing these therapeutic interactions on a daily and yearly basis. As we incorporate increased awareness and increased effectiveness of our therapeutic setting (the milieu), we will create an environment that is welcoming for people to improve their well-being and self-care. From that, we will all benefit.