An Understanding of The Trauma Continuum

This article is an excerpt from Betsy de Thierry’s recent book ‘Teaching the Child on the Trauma Continuum’ (2015), published by Grosvenor Publishing. 

Trauma is defined as an experience that is overwhelming and hinders the child’s safety and security. An alternative explanation is that:
‘Trauma happens when any experience stuns us like a bolt out of the blue; it overwhelms us, leaving us altered and disconnected from our bodies. Any coping mechanisms we may have had are undermined, and we feel utterly helpless and hopeless. It is as if our legs are knocked out from under us.’ (Levine, 2006)

The trauma continuum

Traumatic experiences, and our responses to them, vary widely and therefore it is essential to use a trauma continuum (de Thierry, 2013) to describe how mild or severe a traumatic experience is. I have had conversations with various professionals working with children and young people who say to me, ‘all children these days are traumatised’; however, I would argue that all children know some stress, most will have experienced a crisis, and a large percentage will have endured a traumatic experience, but these would range in severity as shown on the trauma continuum. The consequence of the traumatic experience on the child does depend on the home context and attachments – with positive adult relationships enabling a faster, healthy recovery and unstable, chaotic homes hindering recovery. The trauma continuum can help all those who work with children to use a common language to assess the needs of the child, which consequently enables a child to receive appropriate interventions that are suitable for their level of traumatic response.

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The Trauma Continuum (de Thierry, 2013)

Parenting Capacity on the Trauma Continuum de Thierry, (2013)
This is an essential partner to the trauma continuum to highlight the importance of context in the trauma experience. The beginning of the continuum is a parent who is warm and caring and the other end is a parent who suggests punishment when the traumatic event is mentioned and shows no empathy and warmth.

Trauma can impact a child’s body, brain, memory, emotions, relationships, learning and behaviour.
Evidence has demonstrated that when the adults who work with children have an increased understanding of trauma, then it can immediately impact upon the life of a traumatised child (Alisic, 2012; O’Neill et al., 2010; Sitler, 2008).

The Trauma Triangle

Sometimes the word trauma is used to describe many different experiences and this can create communication difficulty about the different needs and symptoms of the children affected. That’s why we use the trauma triangle to explain the different levels of traumatic experience and response that is needed.

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The Trauma Triangle (de Thierry, 2014)
Complex trauma is the term used to describe the complicated and pervasive developmental and long term consequences of interpersonal victimisation of children involving multiple events and exposure of an extended duration. (Cook et.al., 2005; Coutois, 2008; Luxenburg, Spinazzola and van der Kolk 2001) It describes the dual problem of children’s exposure to traumatic events and the impact of this exposure on immediate and long-term outcomes. Complex trauma outcomes refer to the range of clinical symptomatology that appears after such exposures and these usually present as complex internal systems. This is represented on the top of the triangle.
It can be a common response to ‘just refer’ those ‘complex children’ to specialists, and although that action is most appropriate, it is still essential for professionals to have a grasp of the complexities of their internal workings as well.

Four Major Categories of Childhood Trauma Symptoms which are all experienced at various intensity along a continuum include:
Persistent fear state marked by primitive survival responses such as fight-flight-freeze.
Disorder of memory and trauma related memory disorganization with flashbacks (intense memory recollection) and dissociation (sudden alteration in the integrative function of consciousness)
Dysregulation of affect and the inability to modulate intense emotion
Avoidance of intimacy and aversion to physical and emotional closeness that leads to feelings of vulnerability.
When these symptoms are simple in presentation they are represented in the middle of the triangle and when there are multiple symptoms the child usually develops a complex internal system as seen in the top of the triangle and the end of the continuum.

Common misunderstanding when working with trauma that can create additional traumatic experiences for children:

Practitioners can be trained in an understanding of attachment and emotional literacy (as represented on the foundational layer of the triangle as universal services for all children and young people) and believe that this information is sufficient for understanding children with challenging behaviour. We believe that complex trauma needs to be acknowledged as a reality for many children not coping in mainstream schools and that this requires specialist intervention from experienced mental health professionals.

Those working with highly traumatised children need an awareness of the counter productivity of short term interventions such as 6 weeks of one hour sessions of mentoring or therapy; or 12 weeks of support or other ST experiences where the children will experience the building of an attachment which is then ruptured. This leads to the children experiencing increased confusion and anxiety about relationships and therefore increases the complexity of their coping mechanisms.

Verbal therapies are not usually helpful for children who have experienced multiple trauma’s as they rely on the cognitive abilities that are often ‘offline’ due to the trauma.

SDQ’s assessments that are often used in schools rarely identify complex trauma and can lead to the most traumatised children increasing in compliant behaviour that can lead to long term mental health difficulties unless an appropriate intervention is provided.

Betsy de Thierry IRCT Trustee
Director Trauma Recovery Centre UK

References:
de Thierry, E. (2015). Teaching The Child On The Trauma Continuum. London. Grosvenor Publishing.
Levine. P. (2006). Trauma Through a Child’s Eyes. California. North Atlantic Press

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