BW: Do you think everybody has some level of trauma? If we really look at the basic definition, it seems like we all have some sort of trigger.
GS: Well, I think if you look at epidemiology, the majority of adults, have at least one experience that would be considered “traumatic.” That’s the bad news; the good news is that most people are pretty resilient. If you look at the numbers, 15 to 40 percent of people who have been exposed to a trauma develop a traumatic stress response like PTSD [post-traumatic stress disorder]. It’s a minority — but it’s a large number of people, given the number of people who have been exposed to trauma. Evolution gives us very powerful tools to manage stress and threat, even when the threat is extreme.
BW: Beyond managing or coping, do you think there’s a way to solve the root of the problem, and how does that happen?
GS: If the root of the problem is trauma at a societal level, I’m not sure about that. At least it’s beyond my level of competence and expertise. Certainly, trauma and violence have been with humans over the course of human history and — though I’d like to think we can eliminate it — I’m not very hopeful. On the other hand, there have been specific public policy initiatives that have had impact. For example, early in my career I did a lot of work with children with burns. With policy initiatives related to fire safety, smoke alarms, etc., the rates of burn trauma have lessened considerably. Other public policy initiatives — particularly related to child protection — are really important.
Although root causes at a societal level is a really tough, complex problem. My focus, through TST, has been to focus on root causes for an individual child, related to the child’s care and protection. And though this is also a complex problem, it is much more straightforward to address by being systematic, very clear, and very tenacious to make sure a child gets what they need.
BW: Let’s say somebody has trauma with violence or aggression, and then they reach a point where that particular memory does not trigger a response anymore. Can they fully overcome a trauma in that way?
GS: Trauma Systems Therapy applies a phase-oriented treatment, and there are three phases in it that help a person move forward with their life. Not everyone starts in the first phase; it all depends on what’s going on. The three phases are safety focus treatment, regulation focus treatment, and beyond trauma treatment.
The first phase — safety focused — is when there are ongoing actual threats to a child, or the child becomes dangerously aggressive or self-destructive. So safety becomes a primary concern for intervention in this phase. I wish it were different, but we see lots of kids where their problems are not post-traumatic: their problems are related to ongoing threats in their life. During the safety focused treatment, we are in the environment — in the home, in the school — doing everything to make the environment safe enough, or to get the child to a safer environment.
Moving forward, once the environment is safe enough, then what we focus on is helping the child regulate. In this phase we are focused on helping the child build skills to manage emotion, and to help parents and other caregivers be better equipped to help the child manage emotion as described previously. Once a child is able to have sufficient emotional regulation, then they are no longer shifting to survival states — then we move into beyond trauma.
Beyond trauma is about several things. Now that the child is feeling safe enough in their own environment and can regulate, they can begin to tell their own story — to understand it, to get perspective on it, to really be able to derive meaning of it. A big part of this phase is meaning making. Now that their higher order brain systems are working better, the child is able to think about their future: what does their trauma experience mean for their life, their future? We try to build in culturally syntonic rituals to make sense of what’s happened. We work towards post-traumatic growth — and help them see that although the experiences were terrible, they can learn lessons that make them stronger.
Of course, I wouldn’t wish trauma on anyone, but there are ways to use trauma, to really help a child grow. So that’s what we really work with them in the last phase of beyond trauma therapy. Directly to your question: what I have described could be considered the process of overcoming traumatic stress.
BW: What is your perspective on the mind-body connection when it comes to trauma?
GS: As I described, specific systems of the brain and body are involved in trauma. When it comes to survival, there’s not much distinction. The systems of the brain are provoked and the body responds in a way of self-protection — to maintain the survival of the body. The physiological systems are activated, the endocrine systems are activated — most bodily systems are involved. The body and mind are integrally connected. People have asked if we’d consider integrating body therapies in our Trauma Systems Therapy model. I certainly know that there’s important literature about this. We haven’t integrated this yet, but it could potentially fit into the regulation-focused treatment phase of TST.
BW: What advice do you have for families or individuals that are going through trauma and have limited resources for professional help? What can they do on their own?
GS: The first thing is that if someone has had a really scary event happen to them or someone they know — one thing is to know that people are resilient — grief and fear and sadness are all part of the human experience, and it’s normal and natural for people to be feel painful emotion in the days and weeks after the event has happened. But when emotion around survival keeps getting evoked, it’s not going away, people aren’t feeling safe in their mind and in their body — that is a signal that you may want to seek some help, or some evaluation to know if there is a problem that may require professional intervention.
Whatever it is, whether someone is recovering or will recover, or if they need professional help, it’s always kind of the same. It’s about a person who is experiencing their environment in a threatening way, because of what happened in the past, and it’s about those around them being supportive and helpful and attuned.
So there’s no magic recipe here. If you have someone in your life who’s experienced trauma and is struggling and feeling like their environment is very threatening — after you make sure that there is no actual ongoing threat, the best thing we can do is show love and understanding and support — to simply be there for them. That’s about the best one can do, and it’s really a lot.
This article was originally published in the Spring 2018 issue of Brain World Magazine.
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