By Dr Marianne Trent, Clinical Psychologist
This article is taken from Episode 11 of The Aspiring Psychologist Podcast
I want to start this article in a slightly different way, because I want to make sure that you are looking after yourself. This article features trauma, and thinking about the way that we can work with people experiencing trauma or who have experienced trauma as aspiring psychologists. And it's okay for you to make the choice not to read this if you feel that to do so would trigger you. Perhaps you are not in the current head space where you have the ability to think about this stuff. And it's not to say that you will always feel that way, but if today you are feeling actually this rubs up against some of your own stuff or some stuff that feels really painful, of course, I'm going to be handling it in a compassionate way using my qualified opinions, advice, and guidance, but it's okay for you to choose to look after yourself. If this does sit a little bit too closely to home, you can give yourself permission to come back to this at a future time when you feel like you'll be better resourced to be able to engage with the content without it evoking painful stuff for you, that might feel overwhelming right now. So I wanted to just give you that option and the full informed disclosure really that this might feel like a trickier article than some of the past ones that I have done. Okay. I am very much looking forward helping you think about this really useful and interesting area which we have so much value to bring.
Like I said in the little intro, the little caveat today, we are going to be thinking about working with trauma as an aspiring psychologist. And I won't go over everything that I've just said in my little disclaimer, but just to say that it'll be useful stuff, but might feel gritty and raw and real because of course it is. And you might be thinking,
"Oh no trauma, I've got no interest in working with trauma!"
Perhaps you're thinking that you're going into an area of psychology where trauma doesn't crop up as often. And to you, I would say in my experience, trauma is everywhere and it impacts on all areas of society. So actually I think it's one of the most interesting and relevant topics to cover because it's so unknown about. Even within mental health services, they're not all trauma informed and it can have such a massive impact on people and their lives and the choices and decisions that they make and the things that they've experienced. So I hope you'll find it really useful. And especially if you're going into forensic psychology, it can be incredibly useful.
So, there’s a rudimentary measure called the ACE scale. And what we know about people on the ACE scale is that depending on their score, people are more likely to experience a whole host of physical and mental health difficulties. So for example, people who score four and above on the ACE scale are more likely to experience anxiety, depression. They're more likely to have things like migraines, IBS. They're more likely to be taking prescribed medication, unsubscribed medication, and to be experimenting with drugs too. They're more likely to drink more alcohol units per week than people who score three and below on the scale. They're more likely to have a whole host of difficulties, including some spinal disc, neck and back problems, including I believe some evidence that some heart conditions are more likely in people who score four and above. And of course at the grand end of the scale, they're more likely to spend time in Her Majesty's prison.
And so that it's where the particular relevance comes in for forensic psychology. Because of course, what we are looking at is often a prison population full of traumatized people. And there's a really interesting book on this by Chris Daw QC who's one of my LinkedIn connections and his book is called Justice on Trial. And I found it a really interesting read to help think about the justice system and how it might need a shake up. So if you wanted to do some reading kind of around this topic, but a non psychology stance. So he's a QC. He writes well. I listen to it on Audible because that's where I listen to my business books and clinical relevant books and stuff around that. And so I found that really interesting. So you might well find that useful too if you wanted to think some more about the justice system and I liked his ideas on that. So hope you do find it useful if you do give it a go.
So this ACE scale, it's 10 questions and it covers a number of different life areas. So it covers sort of perceived threat. All of these question to the first 18 years of life. So perceived threat, actual physical threat and violence, parental separation, parental ill health through mental health reasons, parental drug use, alcohol use, sexual abuse, and a number of other factors. But all of these will come out with someone's unique ACE score for their first 18 years of life. And it can be really useful to talk about people's ACE scores with them and to help them to understand the damaging impact that trauma can have on our minds and our bodies.
So sometimes when I go through the evidence that people are more like to have migraines and IBS and spinal disc and neck, back problems they're like,
"Oh, it's like you're reading my medical history. It's like you've been chatting with my GP."
And I haven't, but it feels like I have because they're living a life of a traumatised person and this is what we know happens to people who've been through prolonged trauma in their formative years. And of course trauma does have a massive impact on people after the age of 18 as well. But what we know is that it has a particular impact in terms of developmental trauma in the way that people form their beliefs about themselves, the world, and others around them, from what they experience in their first 18 years.
So it's really important that we know what a traumatised person looks like and what they'll be experiencing and what they'll be thinking. Because what I have found is that it doesn't actually take a super amount of adverse events to score those four points. So it might be that your parents separated. It might be that one of your parents had alcoholism and the other one had depression and then it didn't maybe feel like your family were like other families. That's your four points. And so many people are walking around living their lives, not knowing that technically, they might be experiencing some symptoms of developmental trauma. They might be spending their life feeling like, I feel really anxious. I don't really know why. I feel really depressed but I don't really have anything to be depressed about. And so when they come into therapy for the first time and we think about developmental trauma, it helps them join up the dots and helps make a lot of sense of that.
Please don't think that scoring a high score or even maximum score on the ACE scale means that you are a write-off and there's no chance and you're going to end up in prison because absolutely it doesn't. I have worked with people who score maximum score on the ACE scale and are incredibly pro-social and really wouldn't want to hurt anybody or say anything bad or do anything bad to them. So please don't think that I'm condemning you to a life where you're not a worthwhile person. That's not at all what I'm saying. But what the evidence tells us is that life is harder for people who have experienced trauma. And what I found was when we work with people who might be kind of feeling that they've got depression and anxiety, or they don't feel safe but they don't really know why, that other people might be quite invalidating of them.
"There's nothing wrong with you. It's all in your head!"
And actually when we help people to understand trauma and understand what their experiences were. Perhaps if they were all scared of their dad growing up and if dad was violent growing up or hit Mum, this has an impact on people and their lives and it can help them to understand themselves better and it can help them know that actually there's a reason why they feel like this and can give them an approach and a technique. And it can be really validating and really enlightening and help them just recognize the impact of what they've been through. And then to be able to make sense of where they find themselves now and be able to make different choices for themselves and help them to feel safe and calm and soothed and know that they aren't at risk imminently anymore. And we can help to just turn down that risk alert system that allows them to engage in their life in a way that they might not have done at all before. It can be a real privilege working with people in this way.
We might find ourselves working with people who aren't traumatized, but don't realize that they have experienced trauma and that can lead to some interesting and powerful conversations. And when we go through that with people, you might find that they connect to a great deal of sadness about what they've been through and what they've missed out on. And what we know is there can be a real overlap between anger and anxiety and sadness. And so when we are going through this with people, we might find that they also feel angry. They might find that they feel really grieved that this has been something they've been carrying with them so along or that this has had such an impact on them and it shouldn't have done and it wasn't their fault. And we might need to help them manage that anger.
And what we know, certainly from working with people in forensic populations, is that there can be a real overlap between anxiety and anger. So we might find that someone is showing lots of anger and aggression, but actually underneath that, the primary emotion, what comes first, is anxiety. It's fear. But it wasn't safe to express that or tap into that and so what comes out is anger, the secondary emotion. And similarly, when we're feeling really anxious, sometimes it can be really useful to think, actually, I think you're really annoyed. I wonder if you're actually really upset about something that's happened, but it doesn't feel safe to express that. So that can always be really useful to tap into that anger and that anxiety link. And I really like it when people start to tell me off, because it can be a real sign that they're getting better.
So when they are able to assert themselves and when they're able to talk about the things that annoy them, and especially when they tell me that I'm annoying them. I tell them at the beginning of therapy,
"By the time we finish working together, you will tell me how annoying I am and that's okay." And they're like, "No, no, no. No, you're not annoying. There's nothing wrong with you. I absolutely trust everything you say and I'd never say you're annoying." And then by the end of our work they're like, "Oh, Marianne, you're so annoying." And you're like, "Yeah, I know. I know."
And if I do something that's not okay, they're going to have to tell me that. Whereas to begin with, they might be very acquiesce and willing to let me say what I like, which is where we need to be really careful with our power differentials as well. To make sure that we are being respectful when people are perhaps in a state where they're not able to stick up for themselves and advocate for themselves, but with your excellent work I really hope that will come.
And if this stuff is rubbing up against your own wounds, then you might find it helpful to check out my Feel Better Academy, which is a place where you can learn to soothe and stabilize yourself and learn to understand why trauma has impacted on you in the way it has and help you learn skills to feel better and to show up for yourself. If you are an aspiring psychologist, but you haven't experienced trauma yourself, then the Feel Better Academy is also a really useful way of learning those skills so that you can then use them to help other people. Because stabilisation work can be so key and so useful and it's an area that aspiring psychologists are often really well placed to be able to step in and help. It might be that you are able to help think about running a stabilization group, perhaps, or doing some sort of stabilize resources for clients to free up space and capacity for the qualified psychologists [inaudible 00:16:19] be doing. Trauma processing work, perhaps. So yeah, just see how that shakes down in your service.
So what we know is we're all just going through our days with the best resources we've got at any given and time and by upskilling ourselves with new resources, we are creating more flexibility for ourselves and more opportunities to be able to engage more fully with our life. And one of the most helpful things we can do any time of the day really is to check in with our self and just take a breath. So we'll do that together.
Take a breath in through your nose, hold it for a moment, breathe out through your mouth when you're ready. Take a breath in through your nose, hold it for a moment, breathe out through your mouth when you're ready.
Okay. And we can do really good things just with that. It can help us to reengage our thinking brain. My children will start to breathe when I prompt them, and sometimes when I don't, to help them to reengage their wise thinking brains when they might be feeling overwhelmed. And sometimes when Mummy gets cross they're like,
"Mummy, I think you need to take a breath." So yeah, hope you find that useful too. And what you'll notice is when you help regulate clients, that they will come to you in sessions and be like, "Do you realize how many people out there in the world are completely unregulated? They are all over the shop."
And you'll notice that they start to try to regulate those people. So someone I was working with was sharing an office with someone who wasn't managing very well. And my client stepped in and said,
"I think we just need to take a moment. Just drop your shoulders and just take some breaths. Okay."
And then was able to think with the person afterwards about how that felt different.
And so I love it when people start to teach techniques outside of the therapy that they know has worked for them, because it's a way of getting our psychology message to be flung far and wide so that it's not just the people we're working with. I don't think they're all setting themselves up as a renegade therapist, but they are observing where people would also benefit from the sterling work that they've had. So yeah, that's when I really like it when people start coming back in and saying,
"We did some of that breathing. Oh, I did that breathing with my child and they really liked it. It really worked." And you're like, "Yeah, well done you."
So the way that I work with people with trauma is to do stabilization stuff, to use compassion focused therapy, to use the Our Tricky Brain Kit. And then of course, to think about whether we might process any of those traumas with something like EMDR. But actually, sometimes it's enough that people are able to regulate themselves and stabilize themselves. And then they don't necessarily need to process the traumas or they don't want to, because it kind of keeps things more manageable for them. So we don't always need to force clients. Not that we'd force them to do anything of course, but processing trauma is not always the holy grail.
Absolutely we can be client led and it might be that clients come to you for a chapter of therapy. They come to you for the stabilization and then once they're used to tolerating their distress and tolerating the ideas, and they're not judging themselves for their thoughts and they're not feeling as full of shame or guilt, then they might be ready to start thinking about processing. But actually what we are looking for is to alleviate distress. And so if the client is freer from distress, then they might never want to or need to process those traumas. It might be that they've had enough or had as much as they need, certainly for now.
So whatever branch of aspiring psychologist you are, I hope you found this useful.
Thank you again for being part of my world and reading right to the end. Take care and have a lovely day.
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To read more information about Chris Daw QC's Book, Justice On Trial, Click Here.