Trauma, especially for a child, can often be so overwhelming that it encourages the therapist to focus solely on the individual. Yet often, the individual lives within a family system and relies on that family system to truly recover from trauma.
Treating The Traumatized Child: A Step-By-Step Family Systems Approach, the new book by Scott P. Sells and Ellen Souder, takes trauma recovery into the family systems model to offer an approach that is effective, encompassing, and grounded in research.
The authors explain that “There is a lack of research and books on how to integrate trauma-informed practice within the context of strategic and structural family therapy.”
When therapists attempt to restructure a family, reduce behavioral problems, and manage defiant behavior without addressing underlying issues of trauma, Sells and Souders tell us, they are left uncertain as to why families relapse and treatment fails.
What is needed is to move from behavioral stabilization to active trauma treatment. Because while the effects of trauma can affect the family many ways and exposure to the individual’s trauma can lead to vicarious trauma, simultaneous trauma, and interfamilial trauma, the family can also be a source of tremendous healing.
Sells and Souders write, “These family members not only provide support for the child but can also act as an antidote to the trauma itself. The power of the family as this antidote is limitless if they have a clear playbook, clarified roles, and dress rehearsals to practice playbook delivery. In addition, in the process of healing the child, family members heal themselves”
Active trauma work first requires stabilization, but Sells and Souders’ method is meant to address what maintains and perpetuates the trauma.
Unresolved traumatic memories fuel emotional and behavior problems which then lead to conflictual family patterns and ongoing painful traumatic memories. Unforgiveness, unresolved grief, family secrets, abandonment, and lack of nurturance are just some examples of the many things that can create unhealthy family undercurrents.
Sells and Souders give the example of Tristan, an eleven-year-old placed with his aunt when his mother couldn’t afford to pay her utility bills. However, when tension and conflict between his mother and aunt went untreated, Tristan developed symptoms that resulted in psychiatric evaluation and the decision to keep him from his mother. As his symptoms worsened over time, he was placed on numerous psychotropic medications. Only when a family-systems trained therapist addressed the underlying unhealthy dynamic between his mother and aunt did he begin to improve.
Yet traumatic experiences like this can also catalyze healing within the family. Quoting Haley, Sells and Souders write, “The best task is one that uses the [child’s] presenting problem to make a structural change in the family.”
To begin, what is needed is a playbook. By first outlining treatment steps, such as developing a symptoms/stress chart, using a visual drawing — Sells and Souders call this an apple tree diagram — to understand the toxic seeds that drive symptoms, choosing which toxic seeds and symptoms to work on, choosing stabilization or direct trauma work, setting therapy goals, and consolidating gains, therapists can help draw the family into the trauma work and improve treatment efficacy.
However, recovery from trauma is not linear, and Sells and Souders stress the importance of creating lists for troubleshooting potential problems, conducting role plays and dress rehearsals, following decision trees, and identifying and preparing for red flags.
In short, it is important to zoom out before zooming in. “Our traumatized children and families are in a crisis that is compounded by isolation, technology, and a lack of family and community connectedness,” write Sells and Souders.
One powerful strategy is to begin the process of therapy with a motivational phone call. Drawing on key ingredients to motivate even the most resistant audience, the goal is to engage family members before treatment begins, not after.
Here Sells and Souders offer a host of strategies therapists can use, such as the “stick and move” technique which helps structure the conversation, keep clients on track, and keep the therapist in control.
By helping the family understand the direct connection between unhealthy undercurrents and feedback loops, both what happens when these undercurrents go untreated and what is possible with the right strategic interventions, family systems therapists can shift the responsibility for healing away from the traumatized child and onto the entire family.
The hope is that the family becomes engaged and takes pride in creating — with the therapist — a healthier, more fulfilling blueprint for how to interact with one another.
Human beings are social creatures and trauma is rooted in the relationships we develop. Treating The Traumatized Child offers a comprehensive and strategic approach to move trauma into the relational realm where the family system — not the symptomatic individual — becomes the focus of treatment, and where healing the relationships, systems, and structure of the family forms the basis of recovery. It is a book that should be required reading for any therapist treating trauma.
Treating The Traumatized Child: A Step-By-Step Family Systems Approach
Springer Publishing Company, December 2017
Paperback, 392 Pages