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Nancy J. Smyth, PhD, LCSW is Professor together with Dean at the University at Buffalo (UB) School of Social Work. Dr. Smyth has been on the UB faculty since 1991 together with has served every bit dean since 2004. She has worked inward both mental wellness together with addiction handling settings for over 35 years every bit a clinician, manager, educator, researcher, together with computer programme developer. She also is a Board Certified Expert inward Traumatic Stress. Her research, teaching, together with practise focuses on trauma, heart together with soul abuse, together with on working alongside people recovering from those experiences, including the utilisation of innovative handling approaches similar EMDR together with mindfulness meditation.Transcript
Introduction
In the late-1990s, early on 2000s I co-facilitated a grouping for parents who were trying to reunify alongside their children who had been removed from their tending past times the state. Nearly all of the parents who were signed upward for my grouping were women who had confirmed cases of neglect against them, primarily for failing to protect their children against abusive partners. As you tin imagine, this was an intense group. As facilitators nosotros ever listened for moments when parents expressed genuine empathy towards their child's experience, took responsibleness for their actions or inactions, together with demonstrated steadfast dedication to protecting their children. I felt proud of this group, for the most part. There were times, though, that I had the unsettling thought that I was part of a scheme that did non practise what it preached. I think this i mom who had suffered severe physical together with sexual abuse at the hands of her married adult man for years, inward part to protect the kids. In the end, it didn't halt him. Her reuinification programme included attending AA, task training, keeping a part-time task 3 jitney rides away from her home, participating inward private therapy, this group, keeping her theater spotless, together with a distich other things that I can't recall. What I do recall is her proverb that she felt similar the scheme was setting her upward to fail. If her house, attendance, or task performance was anything less than perfect, she would hold upward punished inward the worst way possible - never seeing her kids again. I'll never forget when she said “My married adult man was the same way – at that spot was no room for error. Anything less than perfect together with I'd acquire a beating. But at that spot was only i of him. There are similar vi of y'all. I've felt to a greater extent than abused past times this scheme than I ever did alongside my husband. It feels to a greater extent than similar gang rape, which I know about.” I didn't receive got words for it at the time, but today I'd say that the scheme was retraumatizing this mom past times taking away all of her powerfulness together with sense of command over both her ain life together with that of her children. Now, does this hateful that the scheme should ignore the fact that she did non protect her children from horrendous abuse? No. Of course of instruction not. But it does beg the question, how effective could the scheme hold upward at helping her travel a better, to a greater extent than protective parent, if she likened her experience inward the scheme to gang rape?So, what's the alternative? I'm glad you asked. Today's episode of the Social Work Podcast looks at Trauma Informed Care, i of the most promising approaches to working alongside people without causing additional trauma. And I had the honor of talking nearly Trauma-informed tending alongside Nancy Smyth, professor together with dean of the schoolhouse of social piece of work at the University at Buffalo. There are 3 reasons why Nancy was the perfect invitee for today's topic. First, she understands what it agency to address trauma at the micro, mezzo, together with macro level. She has worked inward both mental wellness together with addiction handling settings for over 35 years every bit a clinician, manager, educator, researcher, together with computer programme developer. Second, she's what nosotros similar to telephone vociferation upward a “content” expert. She is a Board Certified Expert inward Traumatic Stress. Her research, teaching, together with practise focuses on trauma, heart together with soul abuse, together with on working alongside people recovering from those experiences, including the utilisation of innovative handling approaches similar EMDR together with mindfulness meditation. In today's episode, nosotros talked nearly Nancy's involvement inward TIC. She identified the basic assumptions behind Trauma-informed care. She clarified the human relationship betwixt a trauma-informed approach to working alongside clients together with specific empirically supported treatments for people alongside trauma histories, together with handling for people alongside PTSD. She talked nearly some of the ways that she has translated trauma-informed principles into micro-level handling practices. We ended alongside resources for people who are interested inward learning to a greater extent than nearly Trauma-Informed Care, including a bunch of episodes on the inSocialWork podcast series.
Now, the tertiary argue why Nancy was the perfect invitee for today's episode (don't worry – I didn't forget) is that she is i of social work's technology visionaries. She was the driving strength behind the University at Buffalo's honor podcast series, inSocialWork. When UB's podcast serial started inward 2008, some of the most song fans of the Social Work Podcast expressed disdain that someone would make a competing social piece of work podcast series. I've ever been grateful to Nancy together with her colleagues for the fantabulous piece of work they do. Honestly, fifty-fifty if at that spot were 10 podcast serial on social work, nosotros likely wouldn't fifty-fifty laid about to scratch the surface of all of the content that needs to hold upward covered. So, I've never thought of the inSocialWork podcast serial every bit competition. And, truth hold upward told, if I had to compete against their every-two-week production schedule I would lose. So inward the spirit of non-competition together with collegiality, today, Apr 29, 2013, the 2 podcast serial are having a cross-promotion. I'm publishing my interview alongside Nancy Smyth, together with the inSocialWork podcast serial is publishing an interview with… me. inSocialWork's Laura Lewis interviewed me nearly my piece of work on the nation's foremost world arts suicide prevention projection - the City of Philadelphia's “Finding the Light Within” suicide prevention mural together with storytelling website. After listening to my interview alongside Nancy, caput on over to insocialwork.org.
And now, without farther ado. On to episode lxxx of the Social Work Podcast. Trauma-informed Care: Interview alongside Nancy Smyth, Ph.D., LCSW.
Interview
Jonathan Singer: Nancy, thank you thence much for beingness hither on the Social Work Podcast together with talking to us today nearly trauma-informed care. And my foremost query is why are you interested inward trauma-informed care?Nancy Smyth: Well, personally my involvement likely started way dorsum inward my early on days inward practise together with I'll appointment myself here, but inward the belatedly 70s where I was working alongside people alongside serious mental wellness problems together with it became rattling evident to me the extensive trauma histories these clients had, from sexual abuse, physical abuse, a lot of childhood issues together with every bit a land nosotros were starting to beak nearly this together with a lot of these folks also had heart together with soul utilisation problems together with we're trying to figure out what you do nearly all that together with I was fortunate inward I think ‘89 to travel to Cape Cod Institute alongside Judith Herman presenting on her volume Trauma together with Recovery. Actually, she had – I think she had only been publishing it at that dot or it's nearly to come upward out the whole trauma together with recovery model trauma theory together with it really seemed to me similar it was a missing slice for me together with my piece of work alongside clients. And thence over the years I've really worked hard to attempt to acquire people to reckon some of those connections non thence much inward damage of a diagnosis similar PTSD, but agreement how these events inward people’s lives contribute to a lot of the things that nosotros label every bit you know problems or diagnoses together with that really start to touching how nosotros travel nearly providing care. And I think trauma-informed care, people acquire rattling confused nearly it together with it's interesting if you travel together with human face inward the land of trauma together with traumatology, which is you know the report of trauma a lot of the trauma people volition non fifty-fifty know what trauma-informed tending is. It's a motion that started politically from survivors of trauma who are inward the mental wellness system, really based on a lot of inquiry nearly how trauma affects people, but really starting to say, you know, our systems are hurting people. They're really inadvertently retraumatizing people inward the way things are done. And I for certain witnessed that foremost hand. I thought there's something incorrect alongside us treating a trauma survivor inward these ways, but it – you know, it didn’t start to travel something defined every bit trauma-informed tending until much afterward when people started thinking nearly the principles. For me, it became a way to really think nearly the piece of work nosotros were doing inward a context that often made the deviation for people that were non getting better, people that were staying stuck, that were challenging, that were getting labeled every bit untreatable inward you know whatever sort of words, mental wellness professionals used for that or heart together with soul abuse professionals utilisation together with I think were thence often clients that became rattling frustrating together with demoralizing for the staff.
Jonathan Singer: You know the way that you're describing it, it sounds similar this model or this philosophy trauma-informed tending is really a peachy gibe alongside social piece of work because it acknowledges the private experience, correct thence maybe a childhood trauma or maybe some sort of traumatic event, but thence it also says this is non something that occurs inward isolation. It occurs inward a context together with i of the contexts inward which nosotros interact most alongside people is service providers together with thence if the organisation or the agency is doing something that is retraumatizing or contributes to the hurting together with suffering associated alongside the trauma or triggers it thence we're non really helping. And thence it's a existent prissy integration betwixt it's form of the micro together with the mezzo or the macro.
Nancy Smyth: Exactly. And I think that’s i of the things that’s really appealed to me nearly the model is it really does gibe good alongside our profession inward the sense of somebody together with environs together with looking at our systems of care. The core supposition of a trauma-informed tending model is that it's non nearly what's incorrect alongside you, it's nearly what happened to you together with thence it's really a strength perspective inward the sense that many of the things that nosotros define every bit occupation behaviors or symptoms especially symptoms when it comes to people who’ve acquired a diagnosis of personality disorder really brand perfect sense when you start to empathize what happened to people together with you really start to reckon that some of these things were coping strategies that came out of what happened. So those things are form of congruent alongside I think the way social piece of work at its core tries to catch people. What's dissimilar nearly trauma-informed tending is it incorporates the newer information nearly the impact of trauma, trauma together with the brain, agreement issues of triggering together with you know things similar that which nosotros didn’t receive got a potent an agreement of twenty years agone even.
Jonathan Singer: Can you give an illustration of something that mightiness hold upward seen inward damage of a deficit or a occupation that is reframed or reconceptualized every bit a strength?
Nancy Smyth: Yeah. Well, a really pop i that I think most professionals receive got a really tough fourth dimension alongside is cutting.
Jonathan Singer: The self-injurious behaviour that kids or adults receive got been engaging inward to a greater extent than together with to a greater extent than these days?
Nancy Smyth: Yeah, just together with I'm non going to comment that it's ever nearly this, but what I tin tell you is that at to the lowest degree inward many of the people that I've worked alongside I tin beak nearly a instance province of affairs where the customer gave me permission to beak nearly every bit long every bit I don’t seat who she was, but where she would hear to parents alongside horrific fights that would really scare her together with she would enshroud inward the bath together with hold upward terrified together with thence discovered that if she pose her hands similar the wrists upward against the hot H2O pipes together with wound herself, that the feelings got better. They went away.
And what she said is that this was i matter that she could command together with she also had a history inward her theater unit of measurement of when she really liked things they were often taken away from her. So this was something she could command together with that was hers alone. And thence agreement that, you know really beingness able to say to her I acquire it, you know, that it made perfect sense given what options she had to bargain alongside at the time. That response to her was a huge huge alter from how every mental wellness professional person had dealt alongside her upward to that point, which was you can't do this, you receive got to stop, it's bad.
Now, nosotros worked towards stopping, but you receive got to start alongside acknowledging the function, what was working nearly it together with that it was thence of import to her together with for me to sit down together with tell her she has to, you know, acquire rid of it is a repetition of what happened to her growing upward whenever she had something that was valuable to her, people attempt to receive got it away. So that would hold upward a really goodness illustration of “you know nosotros say this is a maladaptive behavior”, but for certain it is now, okay, although it serves a business office now, but the reality is she has dissimilar choices inward her life at nowadays together with she tin acquire some other skills now. She didn’t receive got that at historic menses iv or5.
Jonathan Singer: And every bit you were proverb that, I thought nearly you know maladaptive for whom? I hateful certainly, for certain there's this thought that you don’t desire people to engage inward self-injurious behaviour oftentimes together with alongside increasing intensity because thence – together with nosotros know from the inquiry that it tin displace into thoughts of suicide together with self-harm together with sort of this acquired capacity for hurt, but it's for certain maladaptive for a therapist or provider who’s worried nearly liability, who feels out of control, who doesn’t know–
Nancy Smyth: Yes. We were able to – you know, fifty-fifty inward the 80s together with early on 90s together with I did it i time again late inward my private practice. I was able to convince service providers to piece of work alongside me alongside clients who self-harmed to non automatically demand that they hold upward rushed to an emergency room for a full-pledged evaluation because i time the self-harm had occurred most of the fourth dimension the crisis was over together with to thence demand that you travel upward together with reckon thence together with thence together with pass 5 hours inward the emergency room isn't going to brand a peachy bargain of sense together with thence to throw someone out of treatment, which has often been the response because they’ve repeated the behaviour a few times.
So, I was able to acquire systems to alter those behaviors piece I worked alongside the somebody on developing some other coping skills, but what was of import was doing only the assessment that you said, which is non writing the behaviour off either, every fourth dimension doing a careful human face together with proverb okay, you know, when you gave yourself harm, nosotros receive got to banking concern check in, nosotros receive got to talk, nosotros receive got to reckon where you're at together with brand an assessment nearly whether at that spot is additional run a endangerment at this dot together with thence receive got action.
Jonathan Singer: So this all sounds similar goodness sort of client-centered or customer respectful practice, do you reckon the piece of work that you did inward changing systems every bit trauma-informed care? Is that how you conceptualize it?
Nancy Smyth: I didn’t conceptualize it that way the foremost fourth dimension that I was doing it because nosotros weren't fifty-fifty using those words at that time. The 2d fourth dimension which was inward you know inside the in conclusion 8 years, pieces of that were, yes, absolutely. It's nearly trying to acquire everyone to both empathize the behaviour – I mean, you know, that the inquiry also says nearly self-harm that when someone shows upward inward an emergency room without behaviour that they really acquire high levels of hostility from ER staff together with mental wellness staff because people acquire angry at this behaviour together with thence so helping people reckon the behaviour differently together with empathize that inward context empathize what it's done for someone fifty-fifty where it's come upward from, if the customer is comfortable alongside people knowing that, tin really alter some of the responses of the system.
Of course, you're also working therapeutically to develop other coping skills. You receive got to piece of work alongside a customer on changing those things. So that would hold upward a slice of trauma-informed care, but trauma-informed tending is likely best thought of every bit non – it's non a method, it's a to a greater extent than framework together with a context for which you do your piece of work together with it certainly, it has to piece of work at a scheme level. You can't do it only inward your business office every bit a private practise therapist together with non human face at the scheme exterior of that.
Jonathan Singer: That’s really interesting. So if I saw a private practitioner advertise I practise trauma-informed tending thence you would advise well, maybe I should inquire a distich of questions. Maybe I should observe out what just they're talking nearly because trauma-informed tending is non a practise model similar say cognitive behavioral therapy or motivational interviewing or something of that nature.
Nancy Smyth: No, it really isn't. I hateful it's guided past times fundamental principles, but the methods you utilisation for handling couldn’t hold upward all of the things you only mentioned. If I say I practise trauma-informed care, it tells you something nearly my practise inward the sense that I'm working on principles of collaboration alongside a customer every bit opposed to compliance. I'm working alongside principles of safety, of agreement safety, of agreement the demand for customer pick whenever possible together with I – you know, at that spot are occasionally times that that can't hold upward brought into the place, but those are really pretty infrequent together with empowerment of a client.
So that mightiness tell you, you know, that those are principles that I use, but the ways inward which I utilisation those together with the handling methods aren't going to hold upward clear thence from that. I would for certain human face to reckon someone who does trauma-informed tending to utilisation something similar motivation interviewing because it's rattling compatible alongside that. But I also volition demand to intervene inward systems if that’s appropriate.
Now, you know at that spot may hold upward clients that don’t demand that score of intervention, but for certain when you're talking nearly people who’ve been really affected past times repeated long-term trauma, which are mostly the clients that I piece of work with, they're interfacing alongside many systems together with you really do every bit best every bit you tin to acquire those systems on board together with sometimes you can't together with thence you're working alongside a customer together with helping them non internalize scheme reactions together with agreement that it's a scheme issue. It's non nearly them.
Jonathan Singer: So there's this thought that trauma-informed tending is a framework together with that you tin utilisation dissimilar handling approaches inside that using – together with yet beingness guided past times the principles that you only mentioned. You’ve also mentioned trauma theory together with I'm wondering if you could beak a piffling flake nearly what trauma theory is together with thence I'm wondering if trauma theory is compatible alongside some of these other practise frameworks similar CBT or behaviour therapy together with is it really possible to integrate it alongside these?
Nancy Smyth: Yeah. I hateful trauma theory together with really it's likely to a greater extent than accurately described every bit trauma theories because there's multiple theories at nowadays inward damage of how trauma affects people, but it basically looks at the role of these, you know, sort of horrific experiences inward people’s evolution of self inward the way people relate to the globe together with of the demand for us to contain those understandings into our treatment. Influenza A virus subtype H5N1 really radical seat of trauma theory mightiness fifty-fifty say that most of what nosotros think of every bit mental wellness problems demand to hold upward reconsidered inward low-cal of the inquiry that’s at nowadays emerging, which is that regardless fifty-fifty things similar schizophrenia that, you know, nosotros tin say how potent biological components that the history of trauma is often the matter that is part of the painting that may plow something from only biological predispositions into an actual total blown mental wellness problem.
Jonathan Singer: This factor environs interaction?
Nancy Smyth: Exactly. And you know it may limited itself inward i way or inward some other depending on someone’s genetics, but trauma theory volition also genuinely recognize that i of the things nosotros know rattling solidly from the inquiry at nowadays nearly childhood trauma especially is that the way inward which people care emotion is what's affected past times trauma, thence you acquire emotional dysregulation together with that emotional dysregulation, the inability to care feelings tin present upward inward a whole diversity of mental wellness related problems together with that that’s really what demand to travel after together with to address.
And that’s non to say that the biological issues are non important, but that if you only are treating somebody alongside medication without dealing alongside those other issues, you're likely non going to acquire a lot of existent stability for them.
Jonathan Singer: So you only mentioned emotional dysregulation together with this is i of the sequelae of traumatic events. It changes the way people are able to care their emotions together with I tin imagine somebody alongside an eating disorder or somebody alongside depressive symptoms or a diversity of – or fifty-fifty acting out, oppositional defiant disorder, whatever of these sort of diagnostic labels that nosotros give people every bit beingness associated alongside difficulties regulating emotions.
Nancy Smyth: Yes, absolutely. And that’s part of what trauma theory would say is you know the core hither is trauma together with its impact together with thence the way it gets expressed partly is influenced past times biology. Part of it maybe also past times other environmental influences inward damage of you know whether I plow to substances or if I'm growing upward inward a theater unit of measurement where substances are acquaint together with I'm exposed to them, you know, together with I inward fact tin start to utilisation them at an early on historic menses because of that environment, that may hold upward i way it plays out versus something else.
Jonathan Singer: So would say that this agreement of where problematic behaviors, this supposition that this is where this comes from, is this compatible alongside practise theories – I'll only throw out, together with thence there's cognitive behavioral therapy, at that spot tin hold upward solution-focused therapy, narrative, all these dissimilar handling approaches that nosotros utilisation that nosotros beak about.
Nancy Smyth: I think it tin be. Most – I'm non going to say all approaches because you know there's likely something out at that spot that maybe it wouldn’t gibe with, but I think most people observe that that approach tin inform together with piece of work good alongside a diversity of handling approaches. Now, some people reckon this trauma theory perspective every bit psychodynamic. I don’t really reckon it every bit psychodynamic because I think the deviation betwixt trauma theory together with psychodynamic practise is trauma theory focuses a lot also on the issues of biological scientific discipline together with the lack of emotional processing of trauma together with that you acquire fragmentation of traumatic retentiveness that happens together with that that’s i time again biological together with needs to hold upward addressed through diverse handling methods.
But for certain it wouldn’t hold upward incompatible alongside psychodynamic together with I think that for certain cognitive behavior, social learning theories recognize the role of learning together with coping together with of thoughts inward that process. Solution-focused volition evidently worry less nearly what happened to you, but it's yet rattling strength-based together with focused on solutions together with most often reckon what you’ve been doing every bit an endeavor at a solution. You only demand to hold upward working on some other solutions. So, I don’t think it's incompatible alongside that either.
What nosotros beak nearly though inward trauma-informed tending is that inward improver to taking the approach to the client, which really emphasizes pick together with I think pick together with collaboration empowerment maybe where you run into problem alongside some of the traditional theories together with I think this is non thence much the occupation alongside the theory every bit it is alongside its implementation because I reckon huge variation inward practitioners, but if you're going to involve – give clients some pick inward how treatments provided, you know, at that spot are some traditions that are based to a greater extent than inward the authorisation of the therapist together with inward the sort of blank slate that the therapist should hold upward presenting together with non a lot of self-disclosure.
Now, that’s to a greater extent than classic psychoanalysis than it would hold upward the way psychodynamic theory gets implemented now, but a blank slate – a therapist who wasn’t rattling human together with really only attempt to leave of absence things sort of neutral would likely hold upward rattling activating together with triggering for most really severely traumatized clients because the lack of emotional queues together with of responding would only at that spot hold upward thence much transference that people mightiness non engage inward a therapy plenty to acquire past times it together with I think that’s partly why you could acquire a lot of dropouts.
So, I think it really is partly nearly how the therapist implements the handling together with titrates it. What is recognized inward trauma theory especially inward trauma-informed tending is that the human relationship is critical together with of course of instruction that’s non novel to social work, but it puts an added agreement nearly hither nosotros receive got people past times together with large together with you know, trauma-informed tending becomes especially of import for people who’ve lived through repeated traumas, childhood trauma every bit opposed to something similar 911 where that was the only traumatic trial they had.
That people were wound inside the context of trusted relationships together with that hither nosotros inquire them to come upward inward together with trust us together with nosotros inquire them to come upward inward together with we're inward an authorisation sort of caregiving role thence the recognition that the therapist’s human relationship is going to hold upward triggering from the start together with that what you really demand to piece of work slow alongside that for certain isn't a unique matter to trauma-informed care, but it's i of the key pieces that you really pay attending to.
The other chemical element of trauma-informed tending that I haven’t mentioned together with I think is of import to shout is the emphasis on self-care for the therapist together with for the staff. This is an approach that’s especially of import together with designed for systems similar kid welfare system, you know, grouping homes, juvenile justice, inpatient units every bit good every bit for people who are working independently inward practice, but it's especially essential inward those settings that everybody inward the setting hold upward part of agreement what these treatments are nearly together with that we're paying attending to how the staff are doing together with the impact of the piece of work on the staff.
Jonathan Singer: And thence self-care together with workforce retention, burnout prevention, all of these concepts receive got been around for a long time. Why is this detail or key inward trauma-informed care?
Nancy Smyth: Most of the models of trauma-informed care, together with there's a bunch of them out there, but if you human face at something similar the sanctuary model–
Jonathan Singer: Sandra Blooms.
Nancy Smyth: Yeah, Sandra Blooms sanctuary model, that actively industrial plant at the score of staff – inward other words, the same principles you would hold upward applying to clients receive got to hold upward applied to the staff inward the organizations. So, it's a much to a greater extent than active organizational intervention together with non only let's hold upward worried nearly staff retention. So, nosotros human face at collaboration, choice, empowerment, security every bit it relates to staff inward improver to every bit how it relates to clients.
And inward fact at that spot are assessment instruments to mensurate the organisation on those variables. We've been doing some inquiry on that inward our institute for trauma together with trauma-informed tending to human face at some of those instruments together with reckon how they agree upward together with what nosotros institute are that some of the organizations we've been looking at who say they're doing trauma-informed tending don’t do a peachy task on that other slice of the staff chemical element together with yet nosotros know from some inquiry that Brian Bride did inward Georgia, he looked at social piece of work workforce together with kid welfare workforce inward that State together with I'm sure Georgia is non unique this way, 50% of the workforce qualified for diagnosis of Posttraumatic Stress Disorder related to their work.
Jonathan Singer: Wow.
Nancy Smyth: This is an number for our profession, you know, this number of exposure vicarious traumatization together with I think yeah, I think nosotros come upward into this land alongside our ain histories together with those tin hold upward (assets) together with they tin also leave of absence us vulnerable. And thence I don’t think we're dealing good alongside this every bit a profession. Trauma-informed tending would hold upward casting a special spotlight on that together with on what are the practices inward an organisation that are consistent alongside collaboration, choice, empowerment, all of those things which you're absolutely right, they all contribute to things similar workforce, you know, retaining workers together with to issues of burnout.
But I think because the model has been elaborated to a greater extent than specifically to human face together with mensurate the workforce that way if non only lip service nearly beingness concerned nearly those, it really makes suggestions for intervention. And you know an illustration hither inward the schoolhouse since we've implemented these principles into our MSW curriculum, inward improver to some human rights content, but the trauma-informed tending slice receive got us examining our implicit civilization inward the schoolhouse together with that is a struggle because I volition – higher instruction institutions are hierarchical.
They're non necessarily empowering at all for faculty fifty-fifty together with thence nosotros say well, how tin nosotros every bit a scheme implement every bit many of these principles every bit possible hither together with a elementary determination like, you know, nosotros receive got a pupil who’s getting some bad word from us related to maybe their status inward the school, how are nosotros approaching together with dealing alongside that? How are nosotros taking tending of the staff inward the procedure every bit well? I hateful it focuses our attending on multiple layers where nosotros would non hold upward necessarily doing that except inward maybe extreme situations.
Jonathan Singer: This thought of changing the civilization inward the graduate instruction computer programme I think is such an interesting thought because I know that i of the ways that faculty receive got described or form of reframed the frustration that students often experience inward schools is this is only goodness preparation for what it's going to hold upward similar when you're out inward the agencies inward the organizations. That the feedback you give nearly goodness professors or bad professors or the assignments that seem similar busy work, the you know wasting your fourth dimension together with money, this is what happens inward your agencies together with thence I think that there's maybe a natural language inward cheek, maybe sort of a way of explaining it away of this is – schoolhouse is similar this together with we're non going to alter it because this is how it is out at that spot together with what you're proverb is that if nosotros desire our students who are going to travel the providers to think differently nearly working inward an organisation or a scheme that is really caring together with agreement of things that mightiness trigger someone that it would hold upward of import to brand that alter inward the graduate instruction non only content, but the way that the instruction is provided, the way that the schoolhouse is organized.
Nancy Smyth: Absolutely. And at the same fourth dimension recognizing that at that spot are competing things that the schoolhouse is expected to do for instance gate keeping for the profession, correct because these are non our clients. These are our students, thence you know where do you describe some of those lines? But how do you do it yet inward a humane way, inward a way that really takes total sort of responsibleness together with tending together with whenever possible transparency. And I say whenever possible because evidently you receive got to honour issues of people’s confidentiality together with things similar that inward damage of their educational process, thence it's non a – I don’t think anybody could create a perfect system, but it is to a greater extent than of a procedure together with a struggle I estimate together with people come upward downwards inward some dissimilar places alongside it.
But it's for certain – it's an effort you receive got to brand together with it's absolutely true. People are going to come upward up against barriers out at that spot together with they demand to acquire how to piece of work alongside them, but I don’t think learning how to piece of work alongside them is the same every bit only submitting to them. I think it's, you know, how do you piece of work alongside them? How do you challenge them inward ways that are going to hold upward effective? You know, sometimes you do receive got to pick together with pick out your battles, but to only create upward one's heed I demand to travel – to acquire used to what are inward essence unworkable, unlivable piece of work weather whether it hold upward inward schoolhouse or inward the workforce.
I don’t think we're doing ourselves or our profession whatever favors because I think, you know, I reckon people leave of absence the profession. I reckon people destination upward on disability. I think that there's reasons for that together with when I human face at inquiry similar Brian Bride, similar oh my God, you know, nosotros aren't talking nearly this, 50% I hateful that’s–
Jonathan Singer: Yeah, that’s huge.
Nancy Smyth: It's huge. And we've emphasized a lot of self-care inward our curriculum pieces for our students together with what nosotros observe is that students volition say okay, all right, but they rarely implement it together with I think that what draws us to this land sometimes gets inward the way of us taking tending of ourselves foremost together with trying to assist people pose those pieces together. So, I don’t desire to acquire inward sound similar nosotros haven’t figured out, man child nosotros don’t. We're really struggling alongside it, but we're at to the lowest degree quest the questions together with you know when nosotros human face at a procedure fifty-fifty similar tenure together with putting people through that process, nosotros attempt to do that i time again inward every bit transparent together with humane way every bit possible agreement that it's an archaic procedure together with you know higher ed institutions had their start inward the middle ages together with there's lots of pieces of them that yet appointment dorsum to that.
So, yeah, nosotros attempt to model every bit much every bit nosotros tin together with nosotros do – some of us do amend than others I'm sure together with thence the agencies would hold upward trying to do the same together with the whole dot of the sanctuary model is to actively piece of work alongside the entire agency from the janitor, the receptionist, all of the staff agreement trauma together with agreement the principles of trauma-informed tending together with applying that to everybody, thence you really demand leadership on board to really fully implement this model inward an agency together with a program.
Jonathan Singer: So, you’ve mentioned thence many of import components to this thought of trauma-informed tending together with the to a greater extent than that nosotros beak nearly it, the to a greater extent than that I empathize why it's non something that I understood rattling good because it's multi-faceted, you know, only from the slice that you said that every bit an private provider, you tin receive got a trauma-informed framework together with yet do CBT every bit long every bit you are making every effort to apply these principles, you talked nearly pick together with collaboration, empowerment, but also if you're – you could hold upward a peachy CBT therapist together with you could hold upward peachy at working alongside people alongside PTSD inward damage of reducing those symptoms associated alongside PTSD, but non hold upward doing trauma-informed tending if you don’t think exterior of only that private relationship.
Nancy Smyth: Absolutely, yeah.
Jonathan Singer: That at that spot has to hold upward this conceptualization of my private practise is really a systemic practice.
Nancy Smyth: Precisely.
Jonathan Singer: And I think that that – I think that’s a perpetual challenge inward social piece of work instruction together with for certain it's a existent challenge when you're out at that spot inward the land together with you do receive got a large caseload. You don’t receive got the fourth dimension together with release energy or back upward to think beyond, you know, improving that functioning score or reducing those symptoms or you’ve got 10 sessions that receive got been authorized. And thence at that spot are all of these barriers together with it really sounds similar taking a trauma-informed approach is both consistent alongside social piece of work practise together with also could resultant inward amend outcomes for clients. Is at that spot a inquiry to advise that that is the case?
Nancy Smyth: You know, at that spot is some inquiry that’s rattling preliminary together with it's non for certain similar randomized clinical trial. It's inquiry at the evaluation level. The sanctuary model has been designated every bit a promising practise inward some evidence-based approaches. It's for certain non the form of measure you would human face for, you know, when you beak nearly prolonged exposure or EMDR of both score A, you know, evidence inward damage of lots of randomized clinical trials.
But at that spot receive got been studies that receive got institute reduced restraints, you know, some amend kid outcomes inward similar say kid welfare programs, but the inquiry don’t really demand to hold upward ___. And I think of this every bit beingness an evidence-informed approach important nosotros receive got potent evidence nearly a diversity of things, nearly how trauma affects people. It also is nearly giving people access to trauma-specific treatments, things similar EMDR, prolonged exposure, seeking security things that really address the symptoms because that to me is a human rights number together with it is also trauma-informed care.
Make sure that people receive got access to those treatments every bit good every bit the whole framework of how you're doing treatment, but the, you know really solid evaluation information is non at that spot at the score that scientifically nosotros would desire it. It would hold upward a piffling harder to do it alongside a existent experiment because you are talking systems here. What I volition say is that I think our whole argue inward moving to implementing this approach inward our curriculum had to do alongside feedback from the community.
We had had a trauma counseling certificate computer programme hither inward our continuing ed from nearly only earlier 911 really together with nosotros started getting responses from agencies like, you know, nearly a women’s computer programme that says I desire my entire staff trained inward this because it's making such a huge deviation inward their morale together with their powerfulness to piece of work alongside a total hit of what we're getting. And thence when nosotros got positive feedback from our stakeholders every bit nosotros were trying to create upward one's heed on focus inward the curriculum, those were some of the things that made us say hmm, maybe nosotros demand to human face at this, but I yet think of it rattling much every bit a value-based approach partly together with evidence-informed together with promising practise past times sort of SAMHSA guidelines.
I don’t think SAMHSA has classified it that way, but I do know that I think California had classified sanctuary model every bit a promising practice, you know, advise the emerging evidence, but it's interesting it hasn’t stopped most of the province to moving to this approach inward their systems together with you know similar kid welfare systems around the province seem to hold upward adopting this. Mental wellness systems inward some places say they're adopting this. Now, I say “say” because, you know, it tin all human face goodness on paper.
I desire to know what the experience of the recipients are inward that procedure because that’s really what keeps us honest together with I think the fact that nosotros do bed checks inward a mental wellness unit of measurement inward the middle of the nighttime together with what that would do to trigger a sexual abuse survivor, what beingness pose into restraints does to trigger people who are – receive got been through physical abuse. Those are things that receive got been re-thought every bit these approaches travel to a greater extent than prolific together with I do think that people observe that when you start to individualize together with alter those practices based on someone’s trauma history together with involving them inward what's an advance directive.
When you lose control, how should nosotros intervene alongside you every bit opposed to a global practise that people do observe things similar reduced restraints, but you know a total blown scientific report of all of this is yet yet to hold upward done.
Jonathan Singer: Do you think that some of the displace to adopting a trauma-informed approach is inward part response to our involvement inward Iraq, inward Transitional Islamic State of Afghanistan together with the fact that we're only coming out of the longest military machine engagement inward our country’s history.
Nancy Smyth: Yeah. You know, I don’t think it's responsible for the initiation of this approach because honestly – together with you know this approach sort of got its start across the province earlier these conflicts. But I do think that these conflicts together with agreement trauma together with the impact on folks coming dorsum every bit good every bit you know the other major majority disasters for certain has raised the involvement score for trauma itself together with you know are driving people to pay to a greater extent than attending to trauma models. I suspect it's accelerated it.
However that said, I am non aware together with you know at that spot may hold upward some VA systems out at that spot that are doing a trauma-informed model, but past times together with large I'm non aware that say for instance the VA is using trauma-informed tending every bit a model of treatment. It seems to receive got caught agree to a greater extent than inward the kid welfare scheme nationally together with that’s partly because instead of the centers on kid abuse together with neglect, at that spot was a motion at a policy score to the kid traumatic stress networks around the province taking this approach.
I've seen it to a greater extent than inward addiction handling inward mental wellness tending together with I haven’t heard people much talking nearly it inward handling of veterans which is fascinating. I hateful for certain it fits together with when you human face at how veterans receive got felt about, you know, inward the past times anyway nearly the VA system, it makes perfect sense. I hateful you could lookout adult man an former painting present similar Article 99 which are Vietnam era vets dealing alongside the VA together with reckon how non to bargain alongside trauma-informed care, you know.
Jonathan Singer: It's similar a negative example.
Nancy Smyth: Exactly. And I'm sure the VA is non similar that now, but I also don’t know that the VA has actively taken this approach. And I'm really serious when I say, you know, nosotros hired an extreme events faculty fellow member a few years ago, a psychologist who has done a lot of piece of work inward inquiry inward PTSD together with she’d never heard of trauma-informed model together with she really wrote it upward for the psychological segmentation that deals alongside traumatic stress inward a magazine that’s published every bit part of that segmentation because she said researchers don’t know nearly this together with a lot of the measure trauma handling people don’t know nearly it either.
It really is this sort of parallel perspective that’s developed mostly I think started past times recipients themselves together with addressing tending systems together with non past times researchers working on PTSD together with working on PTSD treatments. And thence they’ve sort of come upward together a piffling bit. There is a national middle for trauma-informed tending that SAMHSA runs together with if you do a search on trauma-informed care, it's ordinarily i of the foremost things to come upward up together with they receive got listed at that spot trauma-specific interventions that gibe good inside a trauma-informed tending model.
You know, the sanctuary model is one, risking connections another. They beak nearly seeking safety. They receive got a diversity of things. The fact that it's at SAMHSA tells us that this is really something that’s moved inward the services together with non thence much from the formal knowledge base of operations of academe together with from research. Policy makers are paying huge attending to it I think because systems receive got struggled alongside some of the issues together with they're looking at the research.
When you're talking nearly 90% of a mental wellness population inward some places together with for certain heart together with soul abuse that receive got important trauma histories, you’ve got to start paying attending to that. And thence you’ve got this whole veterans thing, which I haven’t heard people intersect them much, thence it's form of interesting what you said. I think it's the veteran number together with the state of war receive got contributed to a greater extent than to this zeitgeist of awareness nearly trauma that’s likely fed it, but I haven’t seen it feed it directly.
Jonathan Singer: And thence it's thence interesting.
Nancy Smyth: And that’s only my ain catch together with I'm somebody similar Charles Figley mightiness tell me I'm crazy together with he sees the connections.
Jonathan Singer: So, we've touched on a whole bunch of things hither together with I really really appreciate you providing this overview of trauma-informed care. I was wondering, could you only i time once again summarize what the principles of trauma-informed tending are?
Nancy Smyth: Sure. I hateful I think if you're talking principles, it partly depends on who’s model you're talking about, but essentially you foremost reckon a regulation of it's non what's incorrect alongside you, it's what happened to you together with that handling needs to hold upward guided past times a commitment to security together with collaboration, choice, empowerment together with trustworthiness together with really agreement how that trauma history is going to play out inside the context of handling thence that trust together with security travel paramount, you know, to getting handling started together with that trust volition hold upward key inward the process. And paradoxically for me that volition start alongside my clients past times telling them they shouldn’t trust me until they’ve tested whether I'm trustworthy.
Jonathan Singer: That’s interesting. So when you foremost encounter a client, or maybe non first, but inward the start of your handling you say hey, there's no argue why you should trust me, I receive got to earn your trust or something similar that?
Nancy Smyth: Yes. I hateful I basically – together with it's often inward the foremost session. I hateful it depends on evidently what the customer is coming from alongside the history, but if they receive got whatever form of a history of important trauma, what I'll say is hear you receive got to a greater extent than than plenty experience inward your life to betoken that people cannot hold upward trustworthy. You don’t know me. There's no argue you should only automatically trust me. You are gratis to examine your trust alongside me.
I desire you to do that together with let's beak a piffling flake nearly how you examine trust alongside people. So, you know strangely plenty when you leave of absence alongside that, you engender some trust correct at that moment–
Jonathan Singer: Yes.
Nancy Smyth: – because you're acknowledging their experience together with you know acknowledging what they're likely feeling already which is, you know apprehensive nearly who is this somebody together with tin I trust them. And thence inward normalizing testing trust, all of those behaviors that nosotros similar to label every bit manipulative or whatever, you know, many of those autumn into that category.
Jonathan Singer: Yes.
Nancy Smyth: So at nowadays we've talked nearly how tin you examine it together with how tin you examine it inward a way that mightiness hold upward to a greater extent than adaptive, but also i of the some of the ways that you’ve tested trust alongside people together with you start to acquire that on the table, thence that’s sort of taking a collaborative approach to agreement that number of trust together with how volition nosotros piece of work on this together. Those would hold upward examples of those principles sort of an action, but yes those are the principles that would really guide handling together with that’s why I think fifty-fifty if you're doing this inside your business office together with your customer population may non require huge levels of scheme of score intervention because maybe they're of higher functioning, but it volition touching things similar what's my availability to my clients together with I'm non suggesting that nosotros should all hold upward available all the time, but I wrote a blogpost nearly a customer that I had finished alongside together with I’s close downwards my private practise finally alongside this dean’s task only got besides much together with I gave her some referrals together with she commented nearly how hard it was dealing alongside a therapist who had rattling restricted ways of accessing them important you leave of absence a voicemail message together with they telephone vociferation upward you dorsum together with you acquire inward this dorsum together with forth slice together with what she said is that it felt rattling withholding together with she realized it was triggering, that it felt a lot similar her parents together with her insight nearly that, I thought wow.
And she said, you know, you felt to a greater extent than accessible than that. Now, accessible, I allowed her to shipping me electronic mail non nearly crisis things but you know nosotros talked nearly electronic mail together with nearly the fact I wouldn’t reply instantly. She also was allowed to text me to alter appointments together with things together with I laid lots of boundaries around you do non tell me you're suicidal through text message or through email, you know, those types of things, but because I was accessible inward the ways that she was accustomed to relating to the world, it didn’t experience thence triggering.
So, you know that mightiness hold upward truthful for her together with non truthful for somebody else, but I hateful looking at the ways inward which I'm connecting alongside my clients together with quest that together with looking to adjust them a piffling flake because yeah, you desire to trigger a piffling flake inward the sense that it gives you something to piece of work on, but if someone is thence overwhelmed initially that they can't care because everything I'm doing is hard for them to care thence we're never going to hold upward able to acquire a human relationship started together with piece of work together. So, I do think that those principles sound rattling build clean together with elementary together with it's to a greater extent than nearly using them to examine what you're doing together with really working hard to solicit what your client’s reactions are together with that’s non piece of cake to do because people receive got been taught that they can't hold upward honest alongside people or they're going to hold upward shell upward or you know whatever else, thence you're really working to acquire honest opinions from people nearly what's working together with what's non is an ongoing process.
Jonathan Singer: The examples that you only gave nearly how to plow these principles into practise are really interesting together with I think it's just the form of matter that folks listening to the podcast would dear to acquire to a greater extent than about. Are at that spot resources? Are at that spot either other podcasts or books or articles that you would recommend around the application of these trauma-informed principles together with thence are at that spot other resources for the broader agreement of trauma-informed tending every bit really every bit systems intervention?
Nancy Smyth: Mm-hmm. Let's see, good allow me start alongside the systems of intervention ones because those are likely easier to find. There's a distich of podcasts inward our School of Social Work Podcast Series, used to hold upward called Living Proof, at nowadays it's In Social Work, that I think are especially helpful together with that’s 2 interviews that I did alongside Brian Farragher of Andrus Children’s Center on the sanctuary model together with how they implemented it at Andrus.
You know, he’s the executive managing director at that spot together with he really talks frankly nearly you know what putting that model into practise agency together with their struggles alongside it together with I know that was rattling helpful to me inward understanding. People search for that SAMHSA Center on Trauma-informed tending together with trauma services together with you human face nether the alternative that says what is trauma-informed care. They receive got some interventions listed there. The run a endangerment together with connectedness curriculum is mentioned there.
There's a model called the atrium model together with all of them sort of something called the TREM Trauma Recovery together with Empowerment. They all do render some trauma-specific intervention, but they were all sort of grounded inside some principles of trauma-informed care. I receive got a chapter out inward a Wiley volume which only came out which talks to a greater extent than nearly trauma-informed social piece of work practise together with I think i of my criticisms of this approach is it doesn’t acquire specific plenty for practitioners. I haven’t seen a huge number of things that interpret that inward rattling many specific ways. I could give you a i K 1000 dissimilar examples, but–
Jonathan Singer: Maybe we'll receive got to do a part 2 where you do that. Yeah.
Nancy Smyth: Yeah, yeah, you know because I really think that it comes downwards to – it does come upward downwards to rattling specific interactions alongside people, but I haven’t seen anybody describe the incorrect i together inward i way to really guide what I would telephone vociferation upward to a greater extent than than micro principles. I would say that I think motivational interviewing at its core is what I would inquire tell people to acquire if they really desire to empathize trauma-informed care.
And it doesn’t beak nearly trauma at all, but the principles together with what drives that are thence congruent alongside the core principles. Then you only receive got to receive got that to the adjacent score together with you receive got to inquire the query of how am I operating my practice? You know, how are those things – how do I brand those decisions? How am I involving people inward those – you know, inward what I do? Things similar my policies around how to contact me. Things similar how my business office is laid up.
I hateful I volition ever inquire my clients looking around my office, is at that spot anything hither correct at nowadays that is hard for you to sort of tolerate together with you'll observe out nearly things that are triggers that never inward a i K 1000 years would receive got occurred to you. And thence learning only to inquire those questions, thence you receive got to sort of apply some of those principles inward what you do, but I haven’t seen anyone pose all of that inward writing together with you know maybe that’s only similar a volume or a chapter or something I demand to write inward a to a greater extent than micro level.
Jonathan Singer: Well, that’s goodness to know, too. I think it's goodness to know what resources are out there. I also think it's I fully know what's non out at that spot because if you can't observe something, is it because you don’t know how to human face for it or because it's non there? And thence I appreciate you proverb that, that from your agreement together with what you’ve looked for you haven’t been able to observe something that really brings it downwards to a practice, a micro score inward the sense that we're talking about.
Nancy Smyth: Yeah. And I do think that those links on the National Center for Trauma-Informed Care, those detail models volition beak nearly it at a micro score inside their approaches. They only won't do it at the sort of global. This is trauma-informed tending together with to a greater extent than often than non they’ll do it inside the context of the Trauma Recovery together with Empowerment model together with those – thence those are what I think hold upward goodness starting resources for people.
Jonathan Singer: That’s great. Well, Nancy I really appreciate you taking all of this fourth dimension to render us this overview of trauma-informed care. Is at that spot anything else that you wanted to add together that nosotros didn’t comprehend earlier nosotros destination this?
Nancy Smyth: You know, the only other matter I would add together nearly a resources is together with it's form of buried inward our website which is a problem, but I only really sent it out. I think it volition leave of absence over Twitter at some dot today on our School of Social Work concern human relationship is that nosotros receive got a resources middle on our website at University of Buffalo School of Social Work that Trauma together with Human Rights Resource Center together with inward at that spot there's a link for conference resources together with if you click through that, you'll observe some videos of Sandra Bloom describing sort of a Trauma 101 model, you know. In other words, how does trauma touching people? And some other of video of her talking nearly sanctuary model together with thence every bit good every bit Dr. Andrus who’s talking nearly the ACES report which is Adverse Childhood Experiences together with inquiry that’s come upward out of making us empathize that the number of adverse childhood experiences people alive through predicts a whole hit of wellness problems, mental wellness problems inward adulthood. So, those are peachy gratis video resources for folks together with I think I similar her description of sanctuary model at that spot amend than our podcast on it, which you know nosotros do receive got a podcast on the sanctuary model alongside her, but she to a greater extent than talks nearly how she discovered together with came to the sanctuary model inward the podcast together with it's non thence much peachy overview of the sanctuary model.
Jonathan Singer: Oh, that’s really interesting. Okay. Well, we'll brand sure that nosotros pose that upward at that spot every bit well.
Nancy Smyth: Okay. And at nowadays I give thank you you for having me here. I could beak nearly trauma together with trauma-informed tending forever, thence I appreciate your involvement together with patience.
Jonathan Singer: Absolutely. Well, I think you know if nosotros were having java nosotros could likely beak nearly all afternoon, but knowing total good that people are listening to this inward the motorcar together with on the jitney together with perchance fifty-fifty on the treadmill, likely a goodness fourth dimension for us to destination our conversation. So, Nancy give thank you you thence much. I really appreciate it.
Nancy Smyth: Thanks Jonathan.
[End of Audio]
(0:58:51)
References together with Resources
- inSocialWork podcast: Implementing Sanctuary Model inward an organisation http://www.socialwork.buffalo.edu/podcast/episode_multipart.asp?mp=farragher_sanctuary
- 10 Dr. Sandra Bloom Sanctuary Model (describes how she realized the demand for it): http://www.socialwork.buffalo.edu/community/trauma-conference.asp
- National Center on Trauma together with Trauma-Informed Care: http://www.samhsa.gov/nctic/trauma.asp
- Videos: Sandra Bloom, Trauma 101 together with the Sanctuary Model: http://www.socialwork.buffalo.edu/community/trauma-conference.asp
- Bloom, S. L., & Farragher, B. (2013). Destroying sanctuary: the crisis inward human services delivery systems. New York: Oxford University Press.
- Smyth, N.J. spider web log post; Trauma-informed social piece of work practice: What is it together with why should nosotros care? http://njsmyth.wordpress.com/2013/04/19/trauma-informed-social-work-practice/
- National Child Traumatic Stress Network (n.d.). Birth Parents alongside Trauma Histories together with the Child Welfare System: Influenza A virus subtype H5N1 Guide for Child Welfare Staff. Retrieved from http://nctsn.org/sites/default/files/assets/pdfs/birth_parents_trauma_history_fact_sheet_final.pdf
APA (6th ed) citation for this podcast:
Singer, J. B. (Producer). (2013, Apr 29). An Overview of Trauma-Informed Care: Interview alongside Nancy J. Smyth, Ph.D. [Episode 80]. Social Work Podcast [Audio Podcast]. Retrieved from http://njsmyth.wordpress.com/2013/04/19/trauma-informed-social-work-practice/
/search?q=19/trauma-informed-social-work-practice/">http://njsmyth.wordpress.com/2013/04/19/trauma-informed-social-work-practice/
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