BW: Can you elaborate on the Trauma Systems Therapy model?
GS: The model that we developed builds on the ideas that I’m talking about. The core part of it is a child who has a brain wired to respond with extreme survival-laden emotion and defensive behavior in situations that are not objectively threatening. For such children, suddenly their entire context is experienced as extremely threatening and the child reacts — in the classroom, at home, anywhere, when they perceive these signals, even without being conscious of perceiving them. The brain and body go into survival mode. But that’s only one part of it. The other part that must be addressed concerns everyone and everything around the child — because what goes on — around the child — will make the situation better or worse.
The child I described, for example, responded to a teacher’s tone of voice with a survival-in-the-moment response; the teacher had no idea that his tone of voice had precipitated such an extreme response in the child, and frankly, was not that aware that she was experiencing survival-in-the-moment. All that teacher saw was a child who was staring out the window. Wouldn’t it be great if that teacher were made aware about the child’s vulnerability to that tone of voice, and for that teacher to be helped to be more aware of what might be going on for that child when she stares out the window?
The child also needs help to see that when she hears such a tone of voice from an adult male, it does not mean that she is about to be sexually assaulted. In the bounds of reality we cannot prevent this child from ever hearing such tones of voice, nor should we. Within TST we also work with children to build their emotional regulation skills so that they are better able to calm themselves when they perceive a stimulus that we know reliably leads to survival-in-the-moment. This work is highly individualized, based on a child’s specific vulnerabilities. And with all this knowledge, we build a specific treatment plan to help the child and relevant people around them to help the child manage their states of emotion so that survival-in-the-moment is prevented.
BW: Whether they were involved in the trauma or not?
GS: In general, yes. We want the main people the child interacts with, and who can help, to participate, especially the people who are around the child when the child tends to experience survival-in-the-moment. This can be parents, foster parents, grandparents, teachers, coaches. Whoever we feel is most relevant for the child’s recovery and with consideration of the child’s privacy. We want these people to be more attuned to a child’s emotional state. How much are they able to help the child regulate? How much are they even unknowingly evoking signals of threat that put the child into these survival states?
So the reason for the development of Trauma Systems Therapy is that you can’t treat a child alone, you have to work with his or her context. The therapy focuses on two things at the same time: a child who has disregulation of survival states in specific moments or occasions, and people in the child’s social environment who are necessary to help the child regulate these survival states. Those are the two parts of what we call the “trauma system,” and that is why we call our treatment Trauma Systems Therapy.
I do want to directly address one aspect of your question: whether they were involved in the trauma or not? We are really vigilant about whether the child’s response is based on a past trauma, or a true threat happening in their lives at the time we are working with them. We assess this very carefully. If a child is reacting to a real threat, and they are actually in danger, than the solution is not to help them to better manage emotion. It is to clearly and definitively to protect them.
We have very strong processes within TST to help protect children, including advocacy processes with child protection agencies and family court judges. I feel very, very strongly about this. We must make sure to know if a child is in danger, and — if we believe they are in danger — we have to do everything possible to protect them. Period.
When a child is not in danger from those around them, we work with everyone we can, to help them to help the child manage emotion, so that they can recover from traumatic stress.
BW: How do you implement the model?
GS: Every child is different, so we don’t presume anything. We have a defined assessment process to gather specific information about the child and the child’s environment to be able to build a very specific and highly individualized treatment plan that will focus on what is needed to be effective. This always centers on finding patterns related to the sort of signals that lead to survival-in-the-moment for a child, and the process by which this happens.
For one kid, the signal might be a certain tone of voice. For another, it may be observing a specific interaction between caregivers. It could include specific forms of communication with the child. It could, actually, be any thing. But it’s always a specific thing, that serves to remind the child of past trauma, and evokes a survival state in them. And the child’s pattern of reaction is very specific.
For one child, like the girl in school I described, the reaction was a dissociative state. For another child is might be aggression, or self-destructive behavior, or substance abusing behavior. We simply want to find these regular patterns, and then our emotional regulation interventions and our interventions with those around the child are all specifically designed to help with this problem. If we find the pattern — and we usually find it — there’s a great deal we can do to help. If we don’t find the pattern, it is very hard to help because our treatment can’t be specific enough.
Again, we usually find the pattern. And by finding the pattern of how environmental signals lead to a survival state, we can give people the specific knowledge and skill they need about how they can best help the child. And we can give the child the specific knowledge and skill that she or he needs to manage their emotional states.
BW: Where is the Trauma Systems Therapy model being implemented? Has there been any evidence of its impact?
GS: We’re disseminating the model all the time, and we’re continually working with people who are providing care. I have a team that goes all over the country, training people to do Trauma Systems Therapy. Right now we’re in about 14 or 15 different states in the U.S., and involved with the child welfare system in Singapore. We connect with organizations who are working with kids and families who’ve had trauma and traumatic stress and help them to do their jobs in a better way. We train all types of caretakers, including clinicians, paraprofessionals, teachers, child-welfare caseworkers, foster parents — everyone working with children. Anyone involved with a child should be involved in their care.
We’ve published several outcome studies over the years pointing to the impact of TST. I was really excited about a couple of articles that came out in the last year on the impact of TST on 1,500 children in foster care in the state of Kansas, where we applied Trauma Systems Therapy with an organization called KVC Health Systems, and what they found was that if everyone (all the people around the child) are trained and interact with the child in ways consistent with the TST model, children have improved mental health outcomes, and are able to stay in stable homes for longer period of time.
I think these studies have important implications because they point to the very positive impact of a systems-level intervention. Our aim is to influence the whole system around the child. That’s why we don’t disseminate for an individual clinician or a family, we disseminate for a whole system — we’re looking for that systemic change.
