Noticing Trauma in Visits – How caseworkers can respond to signs of possible trauma

Interview by Nancy Fortunato, Jeanette Vega and Robbyne Wiley 

Glenn Saxe, a developer of Trauma Systems Therapy and professor of child and adolescent psychiatry at NYU School of Medicine, explains how caseworkers can respond to signs of possible trauma.

Q: How can you tell if a parent’s actions are related to past trauma?

A: As a caseworker supervising visits, you may see surprising responses, like a parent getting very withdrawn in certain moments. Over time, you may see patterns to those times when a parent gets withdrawn. Maybe when you look at exactly what was going on, the parent felt like she was being forced to do something, and it may be that “feeling forced to do something” is related to trauma for that person.

In Trauma Systems Therapy, we use the term “survival state” to describe a traumatic stress reaction. What happens in the brain for someone with a trauma history is that something in their environment reminds them, even in a subtle way, of a time their survival was at stake, such as when they were sexually abused or they thought they were going to be killed. The reminder causes the brain and body shift dramatically into a survival state. You may not actually be threatened, but you’re seeing everything around you as if you’re about to be harmed. Everything is colored by threat.

If you’re a caseworker in the room with someone who is shifting in this way, what that means is that the person suddenly perceives you as someone who is about to assault them or harm them.

If I’m sitting with someone and I think trauma might be in the mix, I’m always mindful of their emotional state. When I see a shift in their emotional state, especially if they seem to feel threatened, I’m very cautious about continuing. I don’t want to make them feel even more threatened. I ask myself, “What might be going on?” It could be something small—a certain line of questioning, or even just the way I’m sitting.

Q: What can you do if you think someone has been triggered?

A: If your gut says that someone you’re with is being triggered, and you have any discretion in that moment, I would step back, physically and emotionally. Caseworkers have work to do. There’s news you have to deliver, there’s a plan you have to enforce. But you don’t want to be pushing when someone is getting overwhelmed. You may want to end a certain line of discussion, or take a break. Maybe if you have news you have to deliver, you can plan to approach it differently, another time.

We also need to be curious about why a person reacted the way they did and ask them. It’s important not to presume that we know what someone else’s behavior means. What you’re trying to do as a caseworker is form a relationship with someone, and what we all want in relationships is to be understood. If someone presumes to know me, I’m not going to feel terribly good about that. So forming a relationship involves wonder or curiosity. If I see an angry response, I’m going to say, “Tell me more about why you’re angry and how I can help.”

Beyond that moment, what’s really important is that you facilitate a parent getting a full evaluation for trauma. A trauma evaluation can help a great deal. The person can get referred to treatment to get the help they need. As they come to understand their own experience, they can learn what affects them and how they can respond so they don’t feel so overwhelmed all the time, like they are getting traumatized again.

For caseworkers, if you understand the evaluation and treatment, you can also be more aware of the types of things that would trigger this parent. You can adjust your behavior and way approaching the person so your communications are less likely to be triggering.

If you’re a caseworker who works with trauma over and over again, you are very close to the damage trauma causes, and because we’re all human, it has to affect you. You’re  really dealing with the magnitude of the horror of what one person can do to another. It’s important to be mindful of how you’re managing. Do you have people to talk to about the impact your work may be having, especially at times when you feel overwhelmed? Do you have the knowledge base about trauma and traumatic stress that you need? There are lots of training programs and ways of learning about trauma that can be really helpful.

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