My approach to trauma therapy follows a loosely sequential, four-step process:
- Develop rapport.
- Engage in age-appropriate education about ways trauma can impact people.
- Build skills for emotion regulation, impulse control, and mindfulness.
- Create a narrative of the trauma.
This four-step approach is supported by significant empirical evidence about trauma treatment with youth and young adults.
Most of the trauma survivors I meet with have experienced complex trauma –– which we can define as recurring trauma that is interpersonal in nature and has been perpetrated by someone who’d typically be considered trustworthy.
Survivors of complex trauma are often so focused on day-to-day survival that the emotional and cognitive resources normally allocated to developmental tasks are simply unavailable. If trauma occurred during early developmental stages, it is likely those tasks also went uncompleted.
Often, these impacts become especially evident when children enter their teen years and start addressing the main developmental tasks of adolescence — establishing autonomy and developing identity.
According to Piaget, we organize our world by organizing ourselves. When developmental tasks aren’t successfully completed, it is likely that both the person and their world will be disorganized or chaotic. As a result, a cascade of life problems — including mental health challenges, substance abuse, interpersonal difficulties, and school-related concerns — awaits the survivor.
As these problems multiply, survivors move deeper and deeper into a cycle of stuckness, where childhood adversities, negative peer relations, environmental stressors, mental health disorders, and substance-related problems all start to co-evolve, leading to even further challenges.
We can think of this as developmental debt. Like a credit card that is never fully paid off, not only will the cardholder always have a balance due, but they will probably keep falling even more behind — making it progressively harder to ever catch up.
I believe part of my role as a trauma therapist is to help individuals pay off that developmental debt, so they can get unstuck. With that in mind, I tend to utilize playful approaches to the work I do. This often includes games, experiential activities, and expressive arts.
Such an approach provides an effective way to meet participants where they’re at both emotionally and cognitively. This is especially true for those youth with developmental debt going back to early childhood.
Some treatment approaches seem to assume trauma survivors are fragile or hopelessly damaged. Playfulness has no place is such approaches. I say nonsense. The use of fun and games emphasizes resilience, suggests the possibility of a life beyond victimhood, and helps survivors imagine a world where laughter is the norm.