Evaluation of Someone Else’s Work in the Field
About a year ago, I worked as a Therapeutic Mentor/Therapeutic Training and Support in which I worked with kids and teens on a 1:1 basis. With my Therapeutic Training and Support (TT&S) role, I worked alongside a master’s level clinician during family sessions. There is a specific case that had a strong impact on me that I still frequently go back to when thinking about trauma. For a year I worked with a 6 year old little girl who had endured severe trauma from her biological mother before being adopted into a loving more stable environment. I had the opportunity to work with two different clinicians on this case and was able to get a glimpse into how different clinicians work when it comes to handling trauma cases and to see just how educated they are when teaching and helping families who are going through it.
When the case first opened in November 2015, it was myself as the Therapeutic Training and Support (TT&S), and the master’s level clinician. This clinician stayed on for only a few months. Throughout those months, I observed the way she took approaches to the child and the family and began to notice that the family and child were unresponsive, the approaches were not well thought out, there were some things in regards to trauma that she herself was unsure of but never took the time to learn and figure it out so that she could inform the family. Every week, I had supervision with my supervisor in which we would discuss all of my cases, how I’m dealing with my caseload, and if there was any cases they were beginning to take an effect on me. More often than not this one specific case would come up. I explained to my supervisor that I would go to the sessions an hour early to work with my client 1:1 and it seemed to go okay, but the family sessions were very messy, the client’s behaviors were escalating, and there was only so much I could do on my part. As a TT&S you are to work directly under the clinician and follow their lead, but there was no lead to follow. The family began to look at me as the sole clinical provider in the sessions due to the fact that I was doing more work than the clinician. I was fairly new to being trauma informed in was in the middle of a training class the company offered. It eventually got to the point where the family decided they no longer wanted this clinician working with their family, but wanted to keep me. The clinician was taken off the case, and my supervisor had begun to take over. I watched and observed very carefully how attentive my supervisor was to the family needs and admired and respected the approach that she took to first educate the family on exactly what trauma is, how they need to help their daughter through it, and how they can help themselves through it.
As previously mentioned, myself, as well as my supervisor was apart of an ARC training in which it taught us about kids with trauma and how to approach it with both the child and the family. The clinician taught mainly out of the book that we used from the training, Treating Traumatic Stress in Children and Adolescents: How to Foster Resilience through Attachment, Self-Regulation, and Competency by Margaret E Blaustein and Kristine M. Kinniburgh. There was a section in the book that was reflected on for reference when approaching topics that needed to be taught to the parents during parent sessions:
- Trauma Experience Integration
- Executive Functions
- Self Development and Identity
- Affect Identification Modulation
- Affect Expression
- Caregiver Affect Management
- Attunement
- Consistent Response
- Routine and Rituals
Each of these topics were discussed first with the parent, and then again during family sessions in which the clinician used a more age appropriate approach so that the 6 year old would be able to understand.
Some of what was taught during the training was mentioned throughout this course, and was used during our family sessions. Module 4 of the course reminded me a lot of what was taught during the ARC training as well as what was used during both family sessions with the clinician and during my 1:1 sessions with the client. In module 4, we learned about Reactive Attachment Disorder (RAD), which is something that my client was diagnosed with.
“When children are raised in an environment with grossly negligent or abusive care, especially in the first five years of their life, they may develop RAD. The development of attachment is a normal process in infancy, and dictates a person’s ability to love, trust, develop awareness and empathy for others feelings, to regulate their own emotions, to develop healthy relationships as well as a positive self-image. Healthy attachment can only occur when an infant is consistently attuned to, comforted, and when their needs are repeatedly met. The lack of these factors in the first few years of their life can negatively impact their entire future” (Rousseau, 2017).
For about 8 months I was able to watch and observe first hand my supervisor/clinician walk the parents of my client through exactly what RAD is, the impact that it has on children, the importance of consistency, why our client acted the way she did, and the required steps moving forward. It was expressed that one of the most important things to do as a parent with a child with RAD and a trauma history is to come to a complete understanding of what trauma does to a child on every aspect. She began parenting sessions with a teaching guide and incorporated fun learning activities for when it came time to include our client and it was then that the family and client began to thrive.
Working with two different clinicians on this case I was able to fully evaluate each of their work and how it impacted the family. It became a learning experience of what works for a family and what does not. The most important thing that I took away from my supervisor was to understand the many types of trauma that a child can endure and more importantly how to approach it with clients so that they can learn to understand what a trigger is, what it does to their body, and understanding age appropriate tactics. In our case, with a 6 year old little girl, we used music, dance, art, basically any kind of play therapy to work with her and it turned out to be affective.