You’re a teacher and a therapist by trade. What first got you into working with children and young people?
Was there a specific event or experience? I chose to train in both professions at the same time, aged 18–22, because I wanted to help children who had experienced frightening events. I figured both qualifications would be useful. I was born in Burundi, in Africa, where there was a lot of pain and suffering and therefore was motivated from a young age to try and work out what children needed in order to overcome the impact of the horrific things that happened to them
You went on to found the Trauma Recovery Centre seven years ago. Where did the seed of that idea come from?
Well, I’d been delivering training to many groups of practitioners about trauma, and was always surprised at how few counsellors and therapists were confident in the area. The feedback I was receiving was that they wanted to feel confident, but were actually a little bit nervous about working with children and young people who’d been through horrific experiences. It sounds odd, but one night I had a dream of a centre with a soft play area, a giant castle and lots of therapy rooms with big open spaces full of play equipment. Within six months, we’d renovated a building, started a charity and employed some therapists! We had a waiting list almost immediately, and it wasn’t long before I realised we needed to start new centres and train others, too, to be confident in a trauma recovery-focused therapy approach.
This approach uses the trauma continuum1 to assess how traumatised a child is. The newer therapists work with children and young people who have experienced single-incident trauma, or Type 1 trauma, whereas our more experienced therapists, who have completed our four-day trauma recovery-focused framework, work with anything up to Type II trauma, which is usually due to experiences such as sexual abuse, neglect, domestic violence or repeated bullying. Our experienced trauma therapists work with clients up to Type III, which is trafficked, sexually exploited children and young people, and those who’ve experienced so many horrific things that it’s actually hard to put a reason for referral down on the form.
Starting an organisation to deal with all that complexity is quite a project. Can you tell us a little bit about the initial challenges?
I guess the main challenge with something like this is the fact that everything suddenly has to happen all at the same time, so it’s hard to prioritise. There are websites, which then need logos, which need to be designed, and staff need to be recruited and then they need training in trauma, so training programmes have to be formalised. And funding! We needed that to employ the staff, buy databases and equipment and create referral systems. We also had to start the process of creating a charity, with all the paperwork necessary for the Charity Commission and Companies House. But I loved it all and had a great team to do it with me. We started with 20 children over one day and then slowly grew in numbers and days, and then eventually centres. We have centres now in Bath, Bristol, Bradford, Guernsey and Oxford.
The actual toughest challenge in that first year was that I had a death threat and then four years of harassment, which took up a lot of time and energy to cope with, but was a learning curve in how a particular group of people might not be celebrating our arrival. I had to move my own four children from their schools, move house and live a life with CCTV cameras, and watch as domain names, gmail addresses and Twitter accounts were started in my name to defame me. On the other hand, it was helpful to learn about the impact of trauma in my own life and my family life, and how the police process worked. It also motivated me to keep fighting for those who were going through trauma but didn’t know how to recover from the physiological and emotional impact of it.
It’s almost unbelievable that people would try to sabotage both you and the project. But yes, we adults do at least have some resources and understanding to fall back on. We hear a lot about adverse childhood experiences (ACEs) these days. What do you think are the main causes? And has there been a noticeable increase during the TRC’s existence?
None of us really knows for sure, but I don’t think there’s a huge increase in ACEs really. I think that through education and media attention, we’ve created a culture where people feel a little bit less shame when speaking up about their painful childhoods. However, I also think there are still lots of traumatic experiences that are not spoken about enough, such as traumas where those in the midst of it can struggle with language about it, such as neglect, coercive control, exploitation, or secrets that the child can’t recognise so clearly as being traumatic. For example, when a child is emotionally abused or neglected, they usually don’t know they’re being mistreated, yet they often have an overwhelming amount of strong feelings, such as shame, anger, sadness and frustration. The invisible abuse and trauma means that adults don’t necessarily notice their pain, the children don’t have the words to explain what’s happening, and, instead, they often either withdraw relationally or get labelled ‘naughty’ because of the impact of the trauma on their behaviour, emotions and relationships.
If words are not always available to them, what are the main models you embrace among your staff in helping young people and families recover from trauma?
Well, we all work creatively because of that very fact – that trauma renders us speechless. When we look at the Triune Brain Theory,2 we know that when a person (child or adult) experiences threat or perceived threat, the brainstem and amygdala respond instinctively and physiologically. The response is a sudden focus on survival, with fight, flight or freeze reactions accompanied by a sudden surge of cortisol and adrenaline – all of which then causes the energy to be in the body, with little or no neural activity in the prefrontal cortex or part of the brain responsible for decision making, reflection, rational thinking or speech. There are few words to describe horror, and so we depend on creative methods to enable the subconscious to process thoughts, feelings, body memories, visual or other sensory memories, and begin to make sense of it.
So when we work with complex trauma, we at TRC use a synergy of theories, which we now call the BdT Complex Trauma Recovery-Focused Framework. It’s a synergy of the Watkins and Watkins ego state theory3 with the Structural Dissociation theory of Nijenhuis, Steele and van der Hart,4 plus my own Daisy theory. It’s a theory that enables us to work with complex dissociation as a survival tool that then becomes a huge inconvenience to daily living. We work with the internal coping mechanisms that have fragmented the child into ‘parts’, and we assess how fragmented they are and how the ‘parts’ relate to the others. The aim is to facilitate self-awareness, understanding, respect and then integration of the parts.
How does the actual process of therapy look at the centre, then?
A child is referred by their parent (who is sometimes helped by a professional), unless they are over 16, in which case they can self-refer, and this is then acknowledged with an email. The referral team assesses from the information on the referral form roughly what level of trauma the child is likely to be at. (We can be very wrong, as it’s not always possible to communicate the full picture.) Then they wait until a therapist who works at that level has space. At this point, the parent or teen or young adult is invited to the centre for a referral meeting, where we try to take the story of trauma and general history. The child, teen or young adult is soon offered a space, and the parent stays in the parenting group with a specially trained parent support worker, who leads a ‘parenting the traumatised child’ course. This uses my book, The Simple Guide to Child Trauma,5 as the parent’s handbook. The client stays at the TRC for between 20 weeks and three years, during term time, and with continual assessments and review meetings with the parents. We offer parents who are significantly traumatised their own adult psychotherapy sessions.
The centre runs a couple of other related projects as well as therapy and training. The education one is of interest to us all, as school is a constant topic among our clients. How does this work?
We have children and young people who’ve been excluded or are struggling in mainstream education coming to the centre for longer periods of time – several times a week, actually – and we work closely with the school or help the parent find a school for the rest of the week. The trauma that caused the kind of behaviour that leads to exclusion needs more than one hour a week of therapy, and we also make time for psychoeducation. In the education provision, we’re focused on recovery, not management of behaviour. The aim is to see them transition back into full-time education as their trauma symptoms subside as a result of this recovery.
We also host training courses regularly, and people come from all over the UK to see the centre and learn about how to facilitate trauma recovery.
The other thing we do is the Treehouse Project, which relates to our specialism in supporting those who have been victims of human trafficking.
Trafficked children is a topic some of us will be less familiar with, at least in our casework. Can you put us in the picture about the current need and the way you believe in dealing with it?
There seems to be a lot of emphasis on ‘rescuing’ a child from trafficking, and yet little seems to be about how to help that child recover from the kind of experiences they’ve endured. Sadly, feeding them and loving them is not enough. Their trauma is embedded in their subconscious, they are living in a state of survival, their brain is wired to cope with life in complex ways that they will rarely be aware of themselves, and so they need specialised help that can work confidently with the subconscious and the body. My concern at the moment is that the children are rarely offered recoveryfocused work and instead given listening or care that doesn’t help the subconscious to be processed. These children can often be compliant, and the internal complexity may actually grow in depth and lead to all sorts of long-term physical and mental health problems. I know of few organisations that train professionals in this work other than ours.
I’ve probably been living in a dungeon, but I only heard about your work when we reviewed two of your ‘Simple Guides’ – about child trauma5 and about sensitive boys.6 I’m currently very impressed with your book that preceded these, aimed at teachers: Teaching the Child on the Trauma Continuum.1 This information is so much needed in schools. What has the response and interest been like?
I wrote the Teaching the Child book to capture some of the content of my ‘introduction to working with trauma’ training courses, for those who are so desperate to grasp it fully. It’s now used as a course book for some MA courses about special educational and mental health (SEMH) and SEND children, and I receive emails regularly from professionals who are relieved to have discovered it. The Simple Guide to Child Trauma book5 is often bought in bulk by schools, foster agencies and other groups of professionals. I wrote it for adults working with traumatised children themselves who just haven’t the time or emotional energy to read a complex book. I aimed for it to be able to be read, and the basic concepts be grasped, in an hour.
Trauma training for teachers, mentors and therapists is really important. And I think most parents also really want to know and do their best for their child. Would you say a book or live training has the greater effect?
I wish I could say the books work best, but actually, in my training, I experience people having ‘light bulb’ moments in a way that I don’t think is so possible with books. I use a lot of stories, which, although they’re made anonymous, are based on real client work over 20 years, and these seem to enable the learning to be embedded in real life. Last month, a headteacher sent me an email – and I have permission to quote it here – saying: ‘All the staff were talking about children, the child’s issues from the child’s perspective (and not how the behaviours were impacting on them as teachers); a couple of staff, who have previously been very vocal about the approach of the SLT [school leadership team] being too caring, too empathetic, too soft, have completely changed their attitude, and one of the staff messaged me with this: “It was the best training I have ever had, very thought provoking, and as a result I have begun to understand why we are trying to support children. I am sorry that I haven’t totally understood that before…”.’
This is actually a normal response for groups of professionals. I love to see hope rise, and passion for their roles increase, as they see how much of an effect they can have.
Where I’m seeing most effect and demand for training currently is in education – to train therapeutic mentors and start a therapeutic mentoring room within the school itself. Two school staff members receive 12–14 days of training to be able to work therapeutically, the whole school does the introduction to trauma training, and children who require significant support are assessed by a specialist trauma psychotherapist, who then writes a treatment plan that can be carried out by the trained therapeutic mentors on a daily basis. We don’t have enough psychotherapists to meet the demands nationally, so this is a really effective way to get help for kids within the school day.
That sounds a good use of resources and training. Talking about the school day, before you go, can I mention the hot potato of the moment? We currently have a significant problem with some 24/7 adverse effects of the internet and social media on our young people. What’s your take on this?
The level of involvement and engagement with online and social media forums is hugely worrying and causes such a false understanding of ‘real life’, particularly in the critical period of time in adolescence. It does seem to immediately create a desperate need for increased perfection in body image or the fulfilment of the expectations of stereotypes, which are usually pretty much impossible to fulfil in reality. So teenagers are often viewing the world from a place of comparing themselves to each other’s photos and carefully crafted ‘image’, which creates huge insecurity and detailed comparison, which is significantly damaging to a teenager’s way of interacting with their world. It leads, of course, to a sense of not feeling good enough. This can breed shame at ultimately not being good enough or of value, and stops people celebrating individuality. I do believe it’s having a very negative impact on mental health – anxiety, perfectionism, depression, loneliness – and on the number of suicide attempts.
We need to help our young people experience social interactions that are grounded in normality, increase their outside, non-screen experiences, preferably with other adults who can model to them a ‘normal’ interaction with the world around them. This can ground them into a healthy reality that diminishes the feelings of insecurity and helps them feel that they are ‘OK’ and ‘normal’ – which is a foundational part of feeling a sense of belonging and acceptance.
A final word? The Simple Guide to Understanding Shame in Children7 will be published in October, which I’m really excited about. Shame is the biggest theme that runs through all our work, and I long for a society that can recognise the toxicity of shame, so that we can reduce the negative impact of it by articulating it and voicing it. There will be several more Simple Guides coming out next year, including one on attachment difficulties and one that explores how to support strong girls!
If we can raise awareness about how trauma and shame impact on our emotions, relationships, behaviour and ability to reflect and learn, we can be intentional in building families and communities that focus on the strength of relationship, are emotionally literate, and value the integrity and authenticity that ultimately help facilitate healing and wholeness. Well, that’s my view – and I believe it’s one we probably all resonate with.
1 de Thierry B. Teaching the child on the trauma continuum. London: Grosvenor Publishing; 2015.
2 MacClean PD. The triune brain in evolution. New York: Springer; 1990.
3 Watkins J, Watkins H. Ego states: theory and therapy. New York: Norton; 1997.
4 van der Hart O, Nijenhuis ERS, Steele K. The haunted self: structural dissociation and the treatment of chronic traumatization. New York: Norton; 2006.
5 de Thierry B. The simple guide to child trauma. London: Jessica Kingsley; 2016.
6 de Thierry B. The simple guide to sensitive boys. London: Jessica Kingsley; 2018.
7 de Thierry B. The simple guide to understanding shame in children. London: Jessica Kingsley; 2018 (in press).