[Introduction]

This is a Research in Practice Podcast, supporting evidence-informed practice with children and families, young people and adults.

Georgina: Welcome to this research and practice podcast. This podcast is called Beyond the Slogan: The Reality of Building Trauma informed Social Care Organisations. My name is Georgina Chetwynd and I'm a Senior Research and Development Officer with Research and Practice. I'm joined by Dr  Sheena Webb and Dr Danny Taggart who've both been involved in leading our work exploring organisational approaches to embedding trauma-informed practice. Both Sheena and Danny are clinical psychologists. I was just wondering whether you'd both like to introduce yourselves. 

Sheena: Sure. I'm Sheena Webb and I am a clinical psychologist by background. I've spent most of my career working very closely with social care organisations and I guess multi-disciplinary, multi-systemic kind of contexts, and these days I do a lot of sort of independent work with various partners, really thinking about how do we use what we know about the psychology of things like trauma in a very meaningful way in the real world on the frontline.

Danny: Thank you Georgina. So I'm Danny Taggart and I work mostly now in a university at the University of Essex, but I have previously worked in frontline services and social care where I've run family therapy clinics and worked with children and families on the edge of care. I have a research interest in trauma and I have another research interest in the experiences of families who go through separation, both non-recent family separation and also families who are going through that process now. And like Sheena, I'm really interested in the ways the psychological research in theory can be applied to help frontline practitioners work with some of the most disadvantaged and marginalised families in our communities. 

Georgina: So this podcast is linked with our publication of the same name, Beyond the Slogan, and Sheena has been hard at work writing this for us. This comes out of a big action research project that we've been running over the last couple of years. This change project brought together principle social workers and other leaders from across children's and adult social care in six development days. In these days we learnt and reflected and grew in our understanding of the organisational change needed to embed trauma informed practice. There's been a really big growth, interest and investment in trauma-informed practice over the last few years across social care. And with a growing body of literature and evidence. And from our perspective, we've heard from partners and participants in our workshops saying ‘We thought we understood trauma, but in reality this is complicated.’ The reality and complexity of embedding trauma-informed practice can encounter significant barriers and challenges and so the change project really wanted to delve into the complexities and barriers and to bring together research evidence, practitioner expertise and the experiences of people accessing social care and to come up with a joint understanding as to what a trauma-informed system looks like, and the organisational culture shifts that are needed to turn this into a reality, both for people accessing services and for staff. And so as a result of these development days and the discussions and expertise brought to the change project, Sheena has developed this document which summarises the key themes that came up during the discussions. So this podcast expands and reflects on the learning and the briefing. In this first podcast we are reflecting on what we mean by trauma.

[What do we actually mean by trauma?] 

Georgina: So after this very long introduction, I'll start with my first question, a deceptively simple but also very complicated question. What do we actually mean by trauma? 

Sheena: I mean I think it's funny, because we're I think starting with the most difficult question first. And you know when I was writing the document, this is the thing that really I tussled with and in fact whenever I'm training practitioners, it's usually the first discussion I start with. Because I think in actual fact, there are lots of problems with the term trauma, and I think, you know, one of the things we have to think about first of all is who is defining trauma? And for what purpose? Because in the wider world, trauma gets used I think and misused in lots of ways. I think it means something very different if you're on an A&E ward than if you're maybe a sort of civil litigation lawyer thinking about culpability, than if you're a mental health practitioner thinking about eligibility for a service. And I think we need to recognise that trauma is being used for different purposes. And I think the other issue with the term is, we use it to describe both the experience - what happened, you know, the potentially traumatic event. But we also use it to describe the outcome, and those two things aren't necessarily the same thing. And I think the other problem with it is it's both kind of over inclusive and under inclusive, depending on how you look at it. So some people might say ‘Well, only these things are traumatic, it's got to be this massive big shocking event which often excludes a lot of people who may have experienced long term harm through neglect or emotional harm.’ But then if you widen it out so wide… I think it was you Danny who said to me ‘If everything is trauma, nothing is trauma.’ Wasn't it you who said that? I don't know, maybe I could hand that over to you at that point. 

Danny: Thanks Sheena. Yes, I remember saying that to you and it does, I agree it helps to be specific, and so I'm going to give two examples of things. One that is trauma and one that isn't. So my main area of research and a lot of my clinical work has been with adult survivors of child sexual abuse, and whenever they talk about what happened to them and they try to go through the painful process of remembering in order to process and try and move beyond the abuse that they suffered. They are often really tortured by the memory of that experience, and the memories and the fragmented memories in ways that impact their daily life as adults now. So they often feel a high level of threat and endangerment, even if from an outside perspective their life doesn't feel immediately dangerous, although of course it could also be dangerous as well in the present state, but they feel threatened by something that happened in the past in the present moment. They experienced lots of intrusions, lots of things come into their mind that they don't want to have in their mind. Images, sensations, smells, tastes, sounds in ways that are unpredictable and intrusive and can impact their ability to live day-to-day in a way that is relatively sort of secure and predictable. It can leave people with a real sense of emotional dysregulation, emotional upheaval. So what might look like fairly straightforward tasks like going in and booking an appointment to see a GP or having your eyes tested can be absolutely filled with terror and fraught, and actually be impossible for people because it reminds them of some of the emotional and relational and physical proximity that occurred whenever they were abused, and they had that intrusion into their childlike self. So for me, one thing that I recognise a lot as evidence of a traumatic injury is the instability of time where something that happened 10, 20, 30, 40, 50 years ago can feel like it's happening right now in the room. So that's one example of when I feel like I can recognise trauma in the people I work with.

A counterpoint is an example of what's not trauma. So some of the clinical work I'm doing at the minute is with a group of people who experienced family separation non-recently. So both adult adoptees and birth mothers who experienced forced family separation set, you know quite a long time ago, and one of the frustrations that they expressed to me is everybody talks about our services and the help that we need that it has to be trauma-informed. But what they don't understand is that the difficulties that we're experiencing are not primarily traumatic. We experienced family separation from an adopted person's perspective. They experienced lots of issues around identity formation, autobiographical bewilderment not knowing who they are, not knowing where they come from - a real sense of ambivalence and uncertainty about where their loyalties lie with their adopted family, with their birth family. From a birth parent perspective, I hear lots of things about how much grief they experience, but how the grief that they experience and the sense of loss is not given any social validation in the way that it might do if the person… if a parent lost the child through still birth or death they feel that there's a disenfranchised grief quality, and actually, they find it really frustrating whenever all of those complex and multifarious experiences are lumped into this one word - trauma. And like Sheena said, I think part of the problem with trauma and its relative success is that it's a little word that has to do an awful lot of heavy lifting and it's too much to bear all of that range of human experience. 

Sheena: Yeah, I would absolutely agree with that and I think, you know listening to you, it's a reminder - it's one of the things we talk about in the document isn't there, that there's a, there's a very wide range of human experiences that have the potential to affect us, to shape us, to leave some kind of lasting impact or ongoing impact in our lives but they do it in lots of different ways. And I would say that trauma is one type of experience nested in a whole range of adversities which would include as you've mentioned, grief, but it would also include things like deprivation or denigration, marginalisation, loss. So I think, and I think what happens is the word trauma gets used as a shorthand for any kind of adverse experience that could have impacted you in any way. I think for the purposes of our discussion within this context around organisational functioning, I think where I'm kind of coming from is really thinking about what you mentioned Danny about how experiences that are frightening, that are threatening in some way, set up within us an ongoing response to the world that continues well after that original experience is over. In some ways, I feel like a traumatic event teaches us is a very kind of very specific type of learning experience that teaches us about the world being dangerous in some way, and that has a particular consequences for the way that we process information - the way that we regulate our emotions and our behaviours and how we respond to people. And I think that one of the things that we explore and we're going to talk about today is how what we see in terms of individuals doing that seems to replicate in some way within teams and within organisations as a whole. 
 
Danny: That's really helpful Sheena and I like how you frame the idea of how trauma moves from the individual because of what they bring with them into the systems that they work within. And there was one more thing that you actually said to me, which has stuck with me, is that although trauma, particularly in a mental health context, is characterised as evidence of a mental illness, as evidence of a pathology. And it has some value in being seen as evidence of a state of illness or a mental health problem because that means people can hopefully get access to some support around that. It legitimises something. But one of the things that you said to me Sheena was that we have to remember how adaptive it is, how much the trauma, the traumatised response in a person is an attempt at self protection. So if we have experienced a life threatening event or an event that is threatening to our sense of personhood, it really makes sense to be very vigilant. It makes sense to live in the present moment as if the threatening event from the past was happening again, because that's one of the ways that we're wired to try and keep ourselves safe.

Sheena: Absolutely. I think that pretty much every… what we call symptom of traumatisation makes sense when you put it into the context of the original experience. I think, you know, I think people talk about it as a, you know, sane response to an insane world. There's lots of different formulations of that absolutely, and a lot of you know, what I see when I'm working with people who have experienced trauma, who are still finding their day-to-day life difficult, is it's very often those threat responses and self protective responses that are kind of making it hard for them to live in the world in the moment, in the here and now. 

[Outro] 

Georgina: Thanks so much Sheena and Danny. It's really interesting hearing your unpacking of the complexities of defining trauma and really emphasising the importance of honing down and what we mean. In the next podcast we move to start to explore why we need to think about trauma in relation to social care and we specifically think about how trauma can act as a barrier to relational practice.

Thanks for listening to this Research in Practice podcast. We hope you've enjoyed it. Why not share with your colleagues and let us know your thoughts on Bluesky and LinkedIn.

[Introduction]

This is a Research in Practice Podcast, supporting evidence-informed practice with children and families, young people and adults.

Georgina: Hello my name is Georgina and this is the second in a series of podcasts exploring our publication Beyond the Slogan: The reality of building trauma informed social care organisations. In the first podcast I was joined by Doctor Sheena Webb and Doctor Danny Taggart who thought about what we mean by trauma. They drew out that when talking about trauma we understand this as the impact that experiencing life or person endangering threat can have on our emotions, our relationships and our views of the world. In the second podcast, we explore how these processes, the impact that threat has on us, can in turn impact on frontline practice. Building trusting relationships is at the heart of social care frontline practice.

[How can trauma get in the way of building trusting relationships?] 

Georgina: So my first question is, how can trauma get in the way of building trusting relationships? 

Danny: The dominant narrative about trust in survivors of childhood abuse, in this case childhood sexual abuse, is that they lack a capacity to trust - that their trust mechanism has been damaged and I think that that has some value, because why would you not be mistrustful of people in positions of power and authority whenever the people who were supposed to take care of you and look after you and protect you were the people who harmed you, or the people who failed to protect you and look after you? And often, were the people who didn't believe you when you tried to communicate in one way or another that something terrible had happened. So the problems with trust in survivors of child abuse and the problem of trust in traumatised adults makes a lot of sense.

But the research study that a colleague Susanna Alyce did complicated that picture ever so slightly, and I wanted to mention it because it links us to the organisational responses. What Susanna found when she talked to adult survivors of child sexual abuse is that there was some uncertainty and some ambivalence about trusting institutions, trusting practitioners, trusting professionals, but that it was more complicated than adult survivors not having a capacity to trust. They did. They often had rich, complicated interpersonal lives with love and intimacy in them, but what they had had to learn, for the reasons that Sheena's outlined, they had to learn ways of evaluating risk very strategically. So what Susanna found was that people who had been sexually abused who she spoke to could trust. But we're very good at testing the water - figuring out who was trustworthy, what institution was trustworthy, what organisation was trustworthy, engaging in types of transactional trust where they could get their needs met, but also then in time being able to progress onto a more relational trust, which is the type of work that Sheena and I would do, where hopefully when you work with someone therapeutically over a long period of time you can develop the type of trust that's necessary in order for genuine healing and recovery from complex trauma to happen. So I wanted to mention that because it does acknowledge this difficulty - these attempts to survive can become difficult in adulthood if our lack of capacity to trust means that we can't go to a dentist for example. But also to put the onus of responsibility not only on the survivor who has a deficit of trust, but also on the organisation or the professional that they're working with to think how can we be more trustworthy to people who maybe have had their trust ruptured? 

Sheena: Yeah absolutely, and I would very much agree with that more nuanced view of risk appraisal and self-protection. And I think it's interesting because that reminded me also of the research that has been done and I think it's UCL [University College London] and Eamon McCrory and colleagues who were looking at children who'd been in sort of harmful, you know, early environments and looking at their responses to facial expressions and actually showing that these, you know - there's always been this narrative about children kind of being damaged, you know. But actually, what they were showing was that if you ask these children to detect when a facial expression changed to being negative or threatening they perform better than other children. This is not a deficit or a damage, it's a bias. It's a… the brain or the mind is prioritising a certain type of stimulus in order to stay safe, I guess is the hypothesis. And this is I think really important. We're not talking about deficits or lacking in capacity necessarily, we're talking about what we tune into and why. And I think that is also really important when we think about… there's a lot of reliance on us being these very rational thinkers, being able to use kind of logical, you know, upper brain thinking, and I think one of the really important things to understand about the impact of trauma and threat is that threat kind of trumps all of that right. We don't, when you're in a state of survival, when you're under, when you think that the world is threatening, you actually stop giving people the benefit of the doubt. You can't just be… you don't have time to be flexible and weigh things up. You need to jump towards risk more quickly and that means you're always going to err on the side of caution. And I think again that has a lot of importance when you think about the responsibility of practitioners to think about how they present themselves to recognise that actually little things you do, little things you say are going to potentially set off that threat response, you don't necessarily have as much leeway as you think, but anyway. 

Danny: I think that the point you make about practitioners is really important because I think it can be really wounding for us when we come into work with our conscious, at least intentions to do good and to help people - and that's why we're in this line of work and it can be pretty demanding and not always that rewarding, and so there is a vocational component to what brings lots of us into these professions. And I think to be met with suspicion bordering on hostility is really difficult, because it challenges our view of ourselves as wanting to be nice, helpful, compassionate people. And I think that it really helps to understand that the person we're meeting with may have had people who appeared to be compassionate and caring in their life and then either harmed them or failed to protect them. And it takes it out of that very personal feeling we can have whenever we have not been able to work effectively with someone where we feel both guilty and slightly responsible, and then maybe we blame them for not being the right type of patient or not being the right type of client. And I think they understand how important that preliminary mistrust might be, and helping the person figure out whether they need to feel threatened and what steps need to happen in order for them to feel safer enough to have a different type of relationship. That can take some time, and it can take us sticking with some pretty tricky ruptures and some pretty tricky moments to sort of see that process through. 

Sheena: Absolutely, and I think this sort of brings us on to this sort of, you know, why is an understanding of this concept of trauma and threat helpful and useful for organisations, for social care organisations? And I think it's exactly that, which is that when you understand the level of hyper vigilance that people may have when they're coming into services, you start to understand why things rupture and break down quite quickly, and as you say, sometimes it's to do with the practitioner being faced with a very challenging, difficult interaction that they may not understand or find aversive. Sometimes it's to do with the processes you know, when somebody has to go through quite a kind of impersonal, cold process in order to get help. That in and of itself I think feels anxiety provoking and threatening – ‘Fill in this form,’ sit on the hold music, be passed on to two or three different people. That's a kind of first hurdle that people need to get around as well, and that came up a lot I think in the discussions when we started to think about first contact. There's that really important point when people come into services, a whole richness of stuff came up about what it feels like for people on both sides - both the professionals who kind of knew they were having to kind of do things in a formulaic way that didn't feel quite natural sometimes, and also for people who are using services who felt quite wounded I think sometimes as well. 

Danny: One of the most standout moments from that session when we were talking about that was the example from one of the local authority teams, where they said they have somebody who is consistent, who welcomes people and who will have some connection throughout the case. Because one of the things we know that is difficult for all sorts of families and all sorts of individuals is the chopping and changing and the unpredictability of who is actually going to be in there, in that relationship with them and the level of turnover, and that that's built into the system in ways that is not very easy for people to have control over and it's not within the gift of a practitioner to guarantee that they're going to be steadily available throughout the person's journey through the system. But I was struck by the innovation and ingenuity of some of those teams recognising the need to have some consistency in terms of how people were welcomed through the door, had the process explained to them. And even if the person was not able to stay involved throughout their journey, was able to give them enough of a sense of direction and to make them feel like they were welcome at the beginning. 

Sheena: Absolutely, and I suppose I think the other thing maybe it's important to bring in here when we're thinking about trauma-informed social care organisations is that some of the rationale for this is not just related to those people who have previously experienced traumatic events, but I think it's the recognition, I think. And particularly in adult social care this came a lot. Very often, people are coming into services in the midst of a traumatic event at a time in their lives when they are highly vulnerable in crisis. Maybe they've had a health emergency, a mental health emergency, something catastrophic has happened where what we know about the factors that make it, sort of may turn a potentially traumatic event into a lasting experience… is that how people respond to you in the moment when you're at that most vulnerable crisis point is really pivotable in the way that the mind and the brain processes and learns from that experience. And we know that people can go through extremely difficult experiences, maybe a horrible accident. But if they get compassionate responses from professionals, from family members, you know, if they've, if they are made to feel as safe as possible through that process, they're much less likely actually to go on to suffer long term impacts of their trauma. So I think there's another critical role that social care organisations play when we're thinking about the mitigation of the impact of trauma if that makes sense. 

[Outro] 

Georgina: Thank you so much Sheena and Danny for such an interesting and thought provoking conversation. In our next podcast we start to consider how trauma impacts on organisational functioning more broadly.

Thanks for listening to this Research in Practice podcast. We hope you've enjoyed it. Why not share with your colleagues and let us know your thoughts on Bluesky and LinkedIn.

[Introduction]

This is a Research in Practice Podcast, supporting evidence-informed practice with children and families, young people and adults.

Georgina: Hello, my name is Georgina and this is the third in a series of podcasts exploring our publication Beyond the Slogan: The reality of building trauma-informed social care organisations. In the first podcast Dr Sheena Webb and Dr Danny Taggart thought about what we mean by trauma, and in the second podcast we explored the impact that trauma responses can have on individuals and the people supporting them and we particularly thought about the relationship between trauma and trust.

In this third podcast we think about how individual experience of trauma can be replicated across organisations. We think about the way that emotions like fear and anxiety can get into an organisation’s functioning and how that can impact on individuals across the organisation, but also how organisations themselves respond to threat. We talk about self protective processes. These are ways that we respond to threat to protect ourselves from perceived or actual threats, for example being hypervigilant, wanting to protect ourselves from difficult emotions like shame.

[Why do we need to think about trauma and threat impacting on organisations?] 

Georgina: So my first question is why do we need to think about trauma and threat impacting on organisations? Over to you Danny and Sheena. 

Sheena: One of the things that we see across a lot of services is a reliance on, you know, and I say this as a psychologist, a kind of purely behavioural understanding of human beings that if you reward people for their good behaviour, they'll do more of it. If you punish people for their bad behaviour, they'll do less of it. If you set people targets - if you monitor them and tell them what the criteria are, they will meet those targets. And all of that requires a kind of logical upper brain that hasn't, you know, but isn't kind of being interfered with with emotional dysregulation or threat activation. And I think you know, at the individual level what you often see is a reliance on sanctions based interventions.

So within the classroom you know, ‘If you don't stop talking I'll send you out.’ ‘If you don't stop offending I'll put you into prison.’ But also I think that applies within organisations as well. I think there's this assumption that, you know, ‘Well I'm going to set up my service, I'm going to have 10 practitioners, they'll be able to see this many people with this caseload. I will set them these targets. They will be able to meet those targets.’ And those things work in theory, and the core theory works OK as long as you don't put threat and trauma in the system. And the minute you put threat and trauma in the system, those processes become disrupted because people start to become anxious or activated. Interactions start to become challenging. People start to go into self-protection and it starts to distort and shift and change some of those interactions. And you know, and I think what's really interesting is in trainings one of the things I see is that even when  practitioners are aware - they know that the person they're working with has experienced trauma, right? They recognise that the behaviour that they're seeing in the room is linked to that and is technically not personal because the practitioner is also a human being with life experiences, with a threat system themselves. They will often say ‘I still find it really difficult to tolerate or not to react or not to find myself feeling annoyed or frustrated.’ And I think that's the thing that, and that's where one of the ways in which training alone is not enough knowledge - will get me so far and that is helpful, but I also need help with the emotions that get elicited in me, and the fear that gets elicited in me. For example, if I am working with somebody and they say a very frightening thing, like I'm going to take my own life. And as a practitioner, that's a very frightening thing to have to deal with. And just sort of telling people ‘Well, that's to do with trauma,’ it's not enough you know?

I think we need to… I think Sandra Bloom writes a lot about this idea of, you know… we're not just cogs in a machine, we're living, breathing human beings. We've got to take that aspect of it into account. And so I think when we start to look at what does self-protection look like within organisations, it starts to look like things like hypervigilance, rigidity. You know - trying to control things with very rigid processes or avoidance. ‘Let's just pretend that thing isn't happening,’ ‘Let's avoid that subject,’ ‘That's not our job, that's somebody else's department over there.’ We don't deal with risk to self, right? Or it's dissociation, it's numbing you know?

Some practitioners will say ‘I just go blank, you know?’ And I think over time of course, what we know is that if practitioners are repeatedly faced with these stressful interactions, these distressing situations. Even if you're being really compassionate, you know? You are there with somebody who's really distressed, your heart is wide open, your empathy channel is wide open - of course what we have is the issue of vicarious trauma and that's coming… that comes with that empathic connection. 

So there's so much going on when we start to pull it back into the practitioner level, and then again at the organisational level. I think we have to think about the macro level threats. The organisation as a whole is facing threats from the wider world - decommissioning, budget cuts, media scrutiny, serious case reviews, criticism. It's a pretty unforgiving world, I think, that a lot of services are operating in. And I think if you look at it you can see that they too as an organisation level respond with certain self-protective mechanisms which often involve quite a lot of governance and performance indicators and rules and regulations which I think then have knock on effects on the way that the organisation functions. Sorry I went off on a journey then.

Danny: It's great, and I think to come back to something you were saying at the beginning, I just wanted to give another example of the sort of, the way that emotion and certain types of affect like anxiety and fear can get into the kind of web of the organisational system, into the network, and that it comes to sort of organise itself around it, and the emotion that I think a lot about in relation to complex trauma is shame.

And the reason I think about shame is that a lot of the things that children experience that are abusive in a chronic, ongoing way that tends to lead to a more complex trauma presentation are characterised by experiences that the child needs to take responsibility for. Whether because their caregiver has physically hurt them in some way, and it's unbearable to think that the caregiver is somebody who would be that threatening for no reason, and be that dangerous for no reason. So the child often will internalise that sense of responsibility.

In the case of child sexual abuse, it's likely the perpetrators of child sexual abuse often have a lot of shame about what they're doing alongside a desire to kind of cause that harm. And that shame is a bit unbearable, so it gets located within the child. So these children who are victims of often very  serious violent crimes end up carrying the sense of responsibility which manifests itself in terms of shame.

Now as we know from whenever we were doing the engagement sessions, shame is a really sticky emotion. It's a profoundly social emotion. It's paradoxically both very isolating - when we're in a state of shame, we feel like we want the earth to open up beneath us and to swallow us in because we feel completely ostracised, isolated, on our own. But it's also profoundly social. When someone goes into a very shame based state, you can feel it. And I think that with some of the people with complex trauma, when they come into services they have such a high level of shame, and also shame intolerance about talking about some of the things that have happened to them, that shame can become contagious. And when it becomes contagious it can also infect the practitioners. It can infect the systems that they're in, and I think one of the ways that we see that most clearly is around blame.

So one of the things that Sheena was talking about is the use of blame culture as a way to hold individuals or organisations  accountable, and for me in relation to trauma, the act of blaming someone for something that has happened is often quite a shaming experience for that person or for that team or for that organisation, and finding ways to not be caught with the stickiness of shame is something that often will happen. And I think that very traumatised people can bring some of that into the organisation, but they're met with an organisation that is also shame intolerant - that also can't bear the idea of being responsible. And so things that are very ordinary human feelings - ruptures in relationships, making mistakes, forgetting things, because the underlying and often unspoken issue is about terrible abuse. It can actually become unbearable for anybody to make a mistake because it becomes such a shameful, terrible thing that is located within an individual in order for everybody else not to feel that they've been caught with that contagion. 

Georgina: Just as you were speaking Danny, I was thinking, linking back to what Sheena said about how it can be so like so terrifying for practitioners to hear from someone, kind of, ‘I'm considering taking my own life.’ Then yeah, if practitioners think don't respond in a way that they think, you know, that's appropriate or they would like to - that can be very shameful, and then they need a supervisor to be able to kind of respond, to kind of [discuss] that mistake in a supportive and non blaming way, but kind of that way in which shame can kind of travel all the way up the system. It's really, really striking. Sorry Sheena, I interrupted you. 

Sheena: No I think that's absolutely right and I think you know, I've heard shame described as a fear of someone seeing my badness right? Which I quite like because I always love a simple definition. And I agree with you Danny, that this is something that everybody carries across the whole system. And I think that, you know, it often comes up in supervision. When I'm supervising practitioners and when I dig into what was it about the situation that really worried you? Very often underneath it is ‘I'm worried that I did a bad job,’ right? ‘I'm worried I'm not good enough.’ That is very often buried underneath you know - the anger or whatever else that's been showing on the surface. And I think that one of the… this discussion came a lot in the change project around that when there is this blame culture, when everybody is frightened that they are going to be the one labelled as culpable or responsible, that people are going to see how bad they really are. This fear of exposure that leads to a type of self-protection of, as you said - withdrawing, being guarded, deflecting. Not being, you know, being untrusting - that permeates through the system. And so you'll hear practitioners… a lot of managers will tell me that a lot of their interactions with their practitioners, the practitioners almost come into supervisions defensive before the conversation has even started. ‘Well I haven't been able to do that because I've got too many cases on my caseload’ right? So the guarding against shame happens before anybody's even said anything, you know? If the system is that way organised, and I think you see this parallel at the level of inspections, you know. When organisations know they're going to be inspected, you feel this collective fear that something bad is going to be exposed. And you know, my view would be we probably all have bad things within us. We've all got mistakes.

Organisations can't possibly be working perfectly all the time, and the idea that we're going to maintain this illusion that everything is fine is exhausting, and takes us away from the core values of ourselves. If all I'm doing is trying to protect myself from blame, I'm not really doing what I want to do according to my values. I think it's Brené Brown that always says if perfectionism is driving the car, then shame is riding shotgun, you know?

And so I think this is, this was one of  the very strong themes. And I think one of the things we talk about is, is it possible to have a system where we have accountability without judgement? It's not that we're saying people shouldn't be accountable. Of course, as a social worker I need to work with the parent. I need to try and help the parent be accountable for the safety of the children. As a manager, I need to be accountable for the work of my practitioners. But can I do that in a way that isn't shaming? Well, I was going to say that the other… there's another theme that was quite strong when we talked about self-protection. And the other theme was around need and capacity.

So what came up a lot around, particularly around the frontline was that practitioners, organisations being very aware that there's… they can't meet all the needs of the people coming into services. And that there's a lot of unmet need and a lot of demand on the service. And what it seemed was that that awareness, that feeling, the fear of being overwhelmed almost by demand. The feelings of moral injury around not being able to meet needs or work in the way that you really want to work can at times lead to a self-protective response of being quite rigid, you know? Very rigid gatekeeping. Very rigid processes, and sometimes almost shutting off of empathy. Not deliberately. But I think, you know, if you're being overwhelmed and you're constantly feeling like you're not able to give what you need to give, I think one way you protect yourself is to try and make things not personal in a way. And this goes all the way back to that Isabel Menzies life paper, you know, that we've talked about before, where that's exactly what she observed in the nurses who were sort of overwhelmed by all the needs of the patients and start to detach and compartmentalise and make things more mechanical as a way of coping. 

Danny: And yet the irony is for those nurses, the way that they needed to cope by compartmentalising tasks, developing procedures, finding ways to distance themselves from the patient's vulnerability and illness. By assigning the name… assigning them numbers rather than using their name, did offer in the short term, some relief from the anxiety of being so close to vulnerability, illness and death. But actually, completely alienated them from what brought them into nursing in the first place, which was to minister and care for people.

So that's one of the challenges, and just to pick up on one other thing as you were speaking Sheena, talking about the gap between need and resource availability - the word that came into my mind was hopelessness, and that really interacts in a way with the hopelessness that pervades complex trauma and other types of traumatic injury. There can be an awful sort of dark cloud around people who have had repeated traumatic experiences that have led to further traumatic experiences - economic and social disadvantage and marginalisation, and these are often the people who come in to social care services either as adults or as young people and then parents, and I think that the hopelessness that can be communicated when a person begins to tell their story. And it just is one thing after another, after another, after another. And it feels so overwhelming in terms of what a practitioner may think the prognosis is for that person. When that interacts with an organisational system that is hopeless about being able to provide people with the care that they need and deserve, then you've got a kind of a perfect storm of dark clouds and it can be very difficult to see any light through that, and I think that there is no immediate solution to that. There's no easy hope to be gained.

I think that what we have to do as practitioners and as organisations, and to come back to Sheena's point about supervisors - we really need to be mindful that that is partly the kind of atmosphere that is around and is a real dangerous trap for us to fall into. Because what I see and what I hear from survivors of complex trauma is that often that hopelessness gets located entirely in them as another defensive organisational strategy. They're too complex to treat. They're not psychologically minded. They're not in the right place for help and those… some of those things may have some legitimacy. It's not always the right time for us to have psychological therapy. It may not be the right time for us to be able to receive the help that's offered to us. But I hear that used much too often as a reason to blame our pervasive sense of hopelessness upon the most vulnerable person in the equation. And so I think we have to own some of the moral injury and some of the frustrations of the gap between our intention and what we actually have in terms of resource to apply and to recognise that that's something that comes into our thinking whenever we're imagining what support somebody might need. 
 
Sheena: There's a couple of thoughts that sparked in my mind. One was when you use the term hopelessness it reminded me a little bit about some training recently when I've with practitioners who, they also feel that hopelessness in terms of how they experience the system that they're in - that their work, they'll say ‘This is all very well Sheena, but nothing's ever really going to change. We're just going to keep being here on the frontline.’ They feel a bit like cannon fodder sometimes, I think. And the word that often comes up is relentlessness - that there’s a kind of relentless demand, which I think mirrors the relentlessness of complex trauma. That life always feels demanding, always feels stressful. And I think that exactly as you say, this locating it sometimes, then that gets located in the practitioners. They're not resilient enough. They need to be more resilient. They need to attend to their wellbeing. But even at a macro level, you know, what you were talking about, locating it within the individual, it just reminded me of the narrative that's around all the time about our broken NHS, right? You know, that this idea that you just, you keep putting that onto the… as a narrative, it's very disabling. Like it's, you wouldn't and I think if you then use that parallel about how do you approach trauma treatment? The first thing is to go, as you say, and validate and go, yes things are not OK, you know? But you validate compassionately. Not by going you're broken, but by going ‘Things have been really hard, things have been really awful, I really see what you're experiencing, I really want to understand what life is like for you.’ And you start from that case of acknowledgement and validation.

But I think that is the thing that feels sometimes frightening for organisations to do. Because if we really acknowledge how hard things are for the people we're trying to support, how big their needs are. If we really acknowledge how hard things are for our staff, are we just going to be overwhelmed? And I just don't think it has to be that way, I think. But I think that's the fear, and I think that's why we then go back into that denial and dissociation and just trying to narrow things down, which again mirrors what I think a lot of people do - a lot of people when they're coming into trauma therapy at the beginning you know, kind of want things to change but are also really frightened of letting go of those self protective mechanisms as you said.

But like you were saying about the nurses in the Menzies Life study, those self-protective mechanisms are life limiting. They almost cause more stress. and I think Judith Herman talks about the idea of, you know, that one response to trauma is constriction - that you just try and hold, clamp everything down and keep it safe. But when you're in a state of constriction, you really can't breathe. You really can't live. And I think when you start to see whole organisations organised around mitigating threat, becoming very constricted - constricting their practitioners, very top down ways of managing things. Lots of kind of rules and regulations. You start to see, I think, that's when you start to see things really suffer on the front line. Those interactions on the front line can't be trauma-informed because there's no headspace for it. 

Danny: And I think that constriction that you're describing, and I recognise it in a number of different services that I've worked in and worked with. I think one of the signs of that is an overemphasis on slogans, and that kind of links to the brilliant title of your paper. And also one of the major problems with trauma-informed care is that it's possible for those principles to operate at the level of slogans. And it's possible for organisations that are in a highly constricted, highly threat organised and highly traumatised state to reach for the core principles of trauma-informed care - put them on lanyards, put them on the website, put them, you know. And for them to have no bearing and no relationship to how people actually feel, to how they relate to one another and to how they practice in terms of working with the families and individuals that come into the service.

And for me as somebody who's been writing and thinking about trauma-informed care for almost 10 years now, it is one of the reasons why I have a lot of sympathy with practitioners who are a bit fed up listening to it. And yet whenever I listen to you, Sheena, and we're talking, I feel incredibly energised not by the simplicity of the slogans, but actually by their complexity. But also by how radical they are because we can really disrupt lots of the assumptions of how people should be cared for. Of how we understand the difficulties that they face. Of the importance of how we are relationally beyond what techniques or what strategies we might use. And it's real sadness for me when I see trauma-informed care being used in that slogan area way. Because it's a sign that the organisation is using it as almost like a sort of a life raft to keep itself afloat - to try and convince itself that it still has some moral purpose. And I think the messiness and complexity and contradiction of the way that we've been talking about it today is a much more real application of trauma-informed care because it doesn't pretend to be easy. But for me, there's a lot of hope in that. 

Georgina: And yes, thinking about, sorry Sheena, just thinking about yeah, just thinking about the pressure on organisations to come up with quick and easy solutions to this. And I was like, just feeling the pressure, just in this podcast to like tie this up in a nice easy conclusion. ‘And then and then we do this and it's all going to be OK.’ But Sheena, in your briefing, you talk about the power of staying in the meaning making space. Of not jumping straight from the problem to the solution. And just actually… we're speaking Danny. I was thinking about, you know, kind of this hope and these possibilities that can come up when we do hold on to this meaning making space. It can be so hard when we have… kind of all these pressures to come up with solutions. So I won't try and tie up this podcast in a nice easy solution. We are staying in the meaning making space as hard as that can be sometimes. 

Sheena: I think it is hard. I think we… but I think you're right. We have to be patient and we have to allow space and time for meaning to… it usually emerges if you stay in that place for a while. The solutions, better solutions emerge, I think. Rather than quickly jumping, reaching for something that we think is going to make it all better. And I think Danny what you're saying about values. And I have to credit you because I'm pretty sure you gave me the idea for the title of this paper. But I think that, I think that's right that we.

There is a tendency… I think there's a good intention behind adopting slogans. I think there's a good intention behind it. I think people… once people come into these services because we have these values already, you don’t need them written on the front of the organisation. The practitioners came in with these sorts of values around care and respect and all the sorts of things that we see circulating. I think one of the interesting things, and we talked about this in Jane’s project, is many of the prevalent models within social care, whether you look at restorative justice or you look at anti-depressive practice or strength-based practice, kind of share the same values, right? We're all striving for the same values. That's not the unique bit about trauma-informed care. That's the bit it shares with the whole - the ethos of social work itself, I think, and many other caring professions.

I think the issue is, going back to your point Georgina, is that it's not about whether we want to be collaborative or compassionate. It's about understanding how trauma makes it difficult to do that in reality. It's about what gets disrupted. How does a really  committed, compassionate practitioner over time start to feel quite cynical and disconnected from their work, you know? Or other ways that happens, you know? That, for example, I may be really compassionately committed. And then because I'm so worried about a client I find myself overextending and working extra hours and crossing boundaries and putting myself at risk. It's understanding not that these values are important, but that they're very difficult to sustain in the real world, in the day-to-day. And that practitioners need help and also, and this comes up a lot when I'm talking to practitioners, the values cannot just apply on the front line between the practitioner and the person using the services. The values have to permeate all of the interactions in the organisation. You cannot, you know, if you're a manager and you, you know, aren't interacting with your supervisees in a way that models and embodies that curiosity and flexibility and compassion, I think it's quite difficult to expect them to be able to then replicate that.

And I think Danny, you made the point previously about, it's a bit like when you work with parenting parents. And you as a practitioner, modelling to the parent how you hope they're going to be with their child. And that has to go all the way to the top. That has to go all the way to senior leadership. And I think one of the things we see is that trauma-informed care tends to get sort of delegated. It's a project that's allocated to somebody over here who then commissioned something to be implemented over here, rather than these values. Let's think about how we embody these values in the way we speak, in the way that we communicate, the way that we physically are, the way we carry ourselves, our behaviour throughout our working day.

[Outro] 

Georgina: Thank you so much Danny and Sheena for such an interesting conversation. There's really a lot to reflect on in your discussion. I think for me, I'll take away the importance about the awareness of the power of shame and how we can make sure that we're accountable for our work without judgement or shame. And thank you very much for listening. I wonder what your key takeaway point will be? If you want to explore these ideas further, please do look for our briefing called Beyond the Slogan: the reality of building trauma-informed social care organisations, and this is on the Research in Practice website. 

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