What does being trauma-informed really mean in practice, (and why every therapist should be).

Trauma-informed care isn’t super recent but it may still elude many older mental health (and other healthcare or social work-y) practitioners. I don’t think it’s malicious but it’s definitely negligent (I feel bad for using that word but it’s accurate). It’s existed since the 90s so people who were qualified before then have (only) a little leeway but not really.

In Australia, the Blue Knot Foundation were pioneers in releasing the first Practice Guidelines for Treatment of Complex Trauma and Trauma Informed Care and Service Delivery (2012). If you’re interested in reading the first draft (there’s an updated 2019 version) see: https://www.blueknot.org.au/Resources/Publications/Practice-Guidelines/Practice-Guidelines-2012

If your therapist (psychiatrist / GP / counsellor / psychologist / etc) isn’t trauma informed it can influence the way they (mis)diagnose their patients.

Complex-PTSD is often misdiagnosed as various anxiety and depressive disorders, bipolar 1 & 2, narcissistic personality disorder, codependent and borderline disorders, ADHD/ADD, obsessive/compulsive disorder, Autism, dissociative disorders, among others.

That’s not to say people don’t need treatment that also fits in line with some of those disorders – trauma can physically change the way your brain forms connections and reacts (but recovery is possible). However, the root of these symptoms is the trauma and so the trauma has to be addressed. So if a practitioner isn’t trauma-informed they may use treatment that doesn’t make as much progress that’s possible.

Recovery is not curing whatever label you have (that you were given). Recovery is to be able to function in day to day life, to have hope and to be empowered to take control. Recovery is feeling reconciled with your sense of self and your symptoms. Part of it may be recognising it’s an adaption that had a purpose (and often worked) to protect you from a traumatic situation but now that the traumatic event is over it’s harming you instead.

It may not be appropriate or work for some people but I have sent that part of me some warmth and appreciation. I wrote a letter to that part of myself/myself to say:

Thank you for protecting me, and I know you’re still trying to protect me. I understand you’re scared because the world has been scary and unfair to us. It’s okay now. I can take care of us now. I’m big and grown and we’re no longer in contact with him. I totally understand that you don’t trust that yet – it makes sense that you would want to wait and see. I don’t blame you but why don’t let me take the reigns now – let me take care of us.

You must be tired being so hypervigilant all the time. I know it was lonely being so scared and anxious all the time. I’m big now. I can take care of us. Why don’t you take a step back, and instead take a backseat and watch how it goes. If I need you again I’ll let you know. Trust me even if you don’t trust the world.

Thank you and I love you,

Big Michelle

So if it’s not ADHD/ADD/Autism/OCD/Bipolar/Etc and doesn’t have a neurological or biological cause then what is are these trauma symptoms/PTSD caused by?

A common cause of C-PTSD people don’t realise is a dysfunctional family of origin (both the families you were biologically born from and/or raised in). That includes emotional neglect which is the most common and most invisible form of trauma. People misunderstand it as a lesser and weaker form of trauma compared to verbal, physical or sexual abuse but that’s not true. It’s just different but can be just or more damaging. Many people who have experience multiple forms of abuse have said it was the worst part.

So many clients have said, “You were the first person to call it abuse/neglect. I grew up with it so I never saw it that way. Yeah but it was abuse/neglect.”

And that’s something heavy to sit with. These adults have been failed by the system as kids and the system has continued to fail them by not recognising what happened to them was trauma with lasting deep impacts across their sense of self, relationships to others and themselves, and that sense of emptiness that people struggle to describe or put a cause to.

Regardless of people’s values, goals and ambitions there is a core truth in the human need to know that someone sees you truly as you are and accepts you (let alone love you). Imagine as a child, you were never seen. That you were invisible in all the ways that counted (your wants and needs, your presence, your spirit, the sense of being wanted). If that happened to you, you don’t develop a sense of self-value because you were never shown how to and many people chase after that feeling (so many people don’t even know what it is or how to describe it).

If you have this trauma, how do you even start to address it if you don’t know you have it? Before you decide to commit to a therapist, check that they’re trauma-informed. It’s existed since the 90s and there’s plenty of training out there (so much training! I recommend Blue Knot Foundation) so there’s no excuse.

Peace,

Michelle

Moving house is mentally exhausting, and how much of your personal life do you decide to share with coworkers and clients?

I’m not physically moving until mid-late January and I am already stressed. I think I’m stressed a reasonable amount for the situation and I’m also balancing it with excitement. So, really I’m complaining for the sake of complaining – which can be therapeutic and bonding!

That relates to my current train of thought – how much of my personal sh*t do I share with my co-workers and clients? I know, I know. There’s no right answer. Everyone’s different, everyone’s work environment and relationships to people at work is different, and so on. Still…

While I was doing my Bachelor of Social Work degree at uni, I was taught to have an absolute concrete hard line between my personal and professional life. Pfft. Boundaries are important but that is impossible – like literally impossible.

Current best practice and training (ugh there’s always better stuff when you’ve already left) shows that social workers/therapist are more effective when they show they’re human. Every social worker I’ve meet agrees that there are hard limits (e.g. don’t add your clients on your personal Facebook!) but the other stuff is a bit more grey and wibbly-wobbly.

I use discretion to decide whether or not something I share is appropriate. I generally follow the principle most social workers follow is – I only share it if it has a purpose and helps the client. That being said, why deny that I’m feeling a bit tired or anything else that shows that I’m human and imperfect? The days of therapists presenting this perfect impenetrable have-my-life-together are over! Or at least for those of us that keep up to date with Best Practice with capital B and P.

You have to model the model – be imperfect, be vulnerable, be human and show that it is okay to be all those things you’re telling clients are okay! If you say one thing then to the contrary then why would the client believe you?

Or relate to you.

Or trust you.

So my point is that I’m really tired guys. Moving sucks. Buying furniture sucks and is so expensive. The dog in the box photo I found is cute though.

And you can always trust me to be honest and imperfect.

Peace,

Michelle

Relationship counselling includes your relationship to yourSelf. (See what I did there? Haha.) And why sometimes you need to tell your inner dialogue to f*ck off. Really!

It might sound woo-woo (which is I phrase I picked up somewhere in the last 6 months from who know’s where but I like it) but it’s true.

Relational living is unavoidable because your inner dialogue exists. Inner dialogue is not when you talk to yourself out loud, or even when you consciously choose talk to your self inside your head, or make a silent sassy comment. An inner dialogue is instinctive and immediate and out of your control. An inner dialogue is reactive tied to your sense of self (and self worth).

It’s that self-critic that tears you apart without permission, the anxiety you get when a silence goes on for too long in a group, the fear that someone doesn’t like you.

It can also be the a positive voice – immediate sense of gratification, feeling validated and connected, etc.

And you can backtalk your inner voice which relates back to how you cannot avoid relationships in life because you will always be in a relationship to yourself. Bummer, I know.

There can be a little bit of an element of CBT and ACT (disclaimer: I’m not massive fan of the models in my work) in the conversation if you want to “get rid” of anxious thoughts and build your self-compassion.

FYI: Self-esteem is built on a value based in comparison to others. Self-compassion is a feeling of warmth and kindness to yourself simply because you exist.

One question I ask clients (which some people may think is unprofessional) is that if they feel comfortable telling that self-critical voice to f*ck off. I know, I know. It’s a little (a lot) strong but it’s good gauge on how people see themselves and how much their concious mind vs subconcious mind are aligned in their motivations to change.

I tell myself to f*ck off all the time (sometimes). Less so now then a year ago. It brings humour into a shitty situation and it’s empowering. It brings energy with it’s aggression, it brings a sense of power and strength, it makes me think that I’m a badass, and it’s silly enough that it makes me smile.

I also swear heaps in my personal life (and some times in my professional life. Oops.) so it fits my personality. It may not fit everyone! And that’s a-ok!

You might prefer to gently say to that inner dialogue – “Hey, it’s okay. I’m okay. You’re okay.” You can also add a thought or fact that challenges the negative dialogue but you don’t have to like – “Bosslady sent you an email after the last meeting about how she really appreciated your input in the group discussion and brainstorm. No reason why that’d be different now”. Sometimes with both people and your Self, a little compassion without confrontation can go a long way in quietening aggression and fear. That’s also a whole other blog – so many blog ideas and so little time (and energy let’s be honest).

Peace,

Michelle

External supervisors and the small world therapists live in

Supervision is a topic I am super passionate about. I believe you should get a minimum of 1 hour of clinical supervision every month. I’m getting 1.5 hours of line management every month, 1 hour of work funded external supervision every 6 weeks, and 1 hour of self-funded external supervision every 4-6 weeks. I used to attend a monthly group supervision (that has since been discontinued). I also co-facilitate caseworker group supervision across 3 offices (but I’m not counting that since I’m not a supervisee).

That’s a lot of supervision. I know.

When I used to work full-time in two separate organisations I had another 2 supervisors on top of that. Messy!

In my speciality of relationship and systemic therapy (with an attachment lens) there’s not a lot of options for supervisors with a degree (mostly Masters due to the limited study options too) and at least 10 years of experience under their belt. I also had some additional criteria – I needed them to have enough degrees of separation from my organisations I want to work for in the future, my current managers, most of my co-workers, etc. You get the picture.

When I was researching potential clinical supervisors in Sydney I had a very short list. I think it was about 6 names – maybe less. I had to cross someone out because they literally worked in my role previously and my line manager was not keen. I crossed off another two people because they lived too far north for me. I crossed off another because they were running group supervision for one of my workplaces. So I had 2 people left over.

It’s been about a year since and through training/work/etc I’ve noted a few more names but it’s still a small group. I’ve attended enough state-wide and national conferences/trainings to know the key players. Word of mouth is both a huge advantage and also very dangerous! A trainer I liked recommended a supervisor I loved, and on the other side at the national conference a group of family therapy leaders recommended a supervisor I had tried earlier and totally flopped with.

Supervision IS NOT just about finding solutions, solving problems and double checking what you’ve done.

Supervision IS about building a relationship of mutual trust and respect. Supervision is a relationship where you are supported to grow.

Supervision’s goal is to create and maintain a long term relationship where you feel emotionally safe enough to expose your vulnerabilities as a person and as a professional, where you are open to be challenged, and comfortable to ask questions about what your supervisor said. It’s about having passionate theoretical and ethical debates, unpacking a session where you would have done everything differently, having someone who you see as an expect recognise your skills and identity as a therapist, where you can grieve and celebrate cases.

It’s about finding the right fit like Goldilocks. Trial and error. I definitely feel different levels of comfort and trust towards different supervisors. Some supervisors are more structured and holding in their approach which can create a sense of safety and security in the space you share. You trust in their ability to contain you. Some are more practical and task based, and provide less emotional support. In contrast, others may not have strong enough boundaries and try pull you into being their emotional drama. In the supervisor-supervisee relationships there can be a variety of dynamics and dangers that occur in any dyad.

I also love peer supervision which I don’t have in my current role – I’ll take a look at options out there or even look at starting my own peer supervision group where we can meet up once of month after work or on the weekend.

Australian Association of Family Therapy Conference 2019 at Melbourne

Hello there,

I’m currently in the middle of day 2 of Australian Association of Family Therapy’s Conference hosted in Melbourne. I’m originally from Sydney so there was some uncanny valley when I stepped out of the airport. Are the streets differently sized to Sydney or am I imagining it?

As a giant introvert I was not looking forward to the amount of people and hours I’ll have to be internally switched on. As a therapist I was peachy keen to get into the presentations and talks. 1.5 days in and I am wiped!

I came with a colleague so there’s also the interesting navigation of spending so much time together in a (semi-)social setting of breakfast, breaks, lunch, dinner, etc. Luckily, we’re both big introverts and also fans of talking about talking about so we can speak openly about when we need some time alone.

This trip has also made me reflect on the evolution of my now as a person and as a professional compared to me as a person and a professional only a few years ago in terms of social anxiety and imposter syndrome. I used to be anxious about finding someone to sit with or appearing busy, preoccupied with appearing to know more than I do, and a whole variety of insecurities related to feelings of inferiority.

Now I pick a spot, sit down and do my own thing. I’m more comfortable with quiet, even silences, and that has been something I’ve consciously cultivated over the last few months. I am a stereotypical Sydneysider who is always on the go, always doing 3 things at once, and over-committing myself.

I’m very consciously slowing myself down for personal and professional development. I think the therapist’s Self cannot be separated from their practice so every change I make in my personal growth has an impact in my practice. I’ve moved away from very cognitive “building insight and reflective capacity” (isn’t that a patronising phrase?) and moved towards processing and experiencing. Emotionally-Focused Therapy’s Sue Johnson’s key phrase “slow down” has made itself home in my couple’s work.

There’s always something interesting both to unpack intellectually and watch in basic fascination of the posturing and negotiating of egos/beliefs/insecurities in a room full of therapists. Most of the attendees are professionally trained to some degree (social work, psychology, psychiatry, etc), some have even worked in this area for decades but no one can escape the insecurity and vulnerability of being human and wanting to be admired.

I love the growing trend of emphasis and recognition of Self of the therapist. This was something that was seen as unprofessional when I was at university. I was taught to cut off the part of me that was human so the only part the client saw was the professional. Bullshit! Evidence now shows that the therapeutic alliance, the being with, the Self, the authenticity and human connection is the biggest part of whether therapy works or not.

I’ve booked into an Open Dialogue / Dialogical Approach training next week and I am excited to see how it can support me in being present, curious and open.

For the conference so far the interesting sessions were about: Attached-Based Family Therapy, Parenting Project (Bowen-based manualised program for parents in CAMHS), and working with transgender/gender diverse families.

Speak soon,
Mish