The New Awareness
In recent years, the substance abuse treatment field has become familiarized with the phrases trauma informed and trauma competent due to widely available training opportunities and conferences.
In my attendance, I’ve witnessed many convincing research scientists and professional speakers touch the hearts of care professionals to the point of which there has been a surge in the desire to see programs change in how dual-diagnosis and trauma cases are approached.
Though change is possible, there are difficulties that can present themselves.
When considering PTSD, most substance abuse treatment professionals still envision that a single accident or catastrophe – such as an isolated occurrence of childhood sexual abuse or a veteran returned from war – is the trigger for these cases.
Although examples like these haunt many of the clients who are undergoing substance abuse treatment, most of the addiction trauma clients seem to fall into the PTSD 2 category, or what we also call complex PTSD.
Complex PTSD is a disorder that forms over time from multiple adverse or traumatic experiences such as traumatizing parenting style, school bullying, multiple abuse or abandonment experiences etc. It is widely accepted that once the brain is “hijacked” by trauma or “wired for trauma”, it is more likely for a person to be traumatized again from lesser stimulus or even from self-inflicted abusive behaviors.
Some of the complex PTSD trauma clients are unwittingly seeking out experiences that are retraumatizing. Professionals refer to this as “trauma-bonding”, when trauma clients recreate their traumatic experiences to re-experience their past trauma.
Professionals understand this behavior, among other things, as living in the “comfort-zone” – creating artificial safety – a place where the traumatized individual knows how to operate and function.
Though complex PTSD is not a part of the diagnosis coding system yet, it is widely accepted by many mental healthcare professionals.
Trauma Behavioral Cycle
Trauma behaviors in conjunction with communication can be difficult to manage in behavioralist substance abuse treatment centers where client behaviors that deviate from the expected norm are not acceptable to the staff.
The lack of flexibility on the staff’s part, and miscommunication most likely inherent in the client, causes many preventable problems for both treatment center staff and the clients.
Due to inflexible staff and poor client communication, a cycle begins. The treatment staff exhibits attitudes of helplessness and in some cases feels resentful which leads to blaming the client who, in the first place, came into the center because of the very behaviors that are now causing trouble within the treatment staff.
In turn, the client feels invalidated, misunderstood and abandoned; most often blaming themselves for yet another treatment and/or relationship failure.
In most cases, complex trauma clients are diagnosed with Borderline Personality Disorder, Narcissistic, Antisocial Personality Disorder or another diagnosis to explain the problematic behaviors, which can be inaccurate.
Sadly, many times a client with these diagnoses suffers from the stigma associated with the label, because they have been branded incurable or at least difficult to treat by many staff members and even mental health professionals.
Trauma clients erroneously diagnosed not only suffer discrimination from treatment center professionals, but also from their peers. Of course, there are many empathetic fellow clients, but if the staff is not vigilant, the trauma clients will most likely be bullied in group settings.
If the staff does not vigilantly manage group dynamics while educating the individuals about trauma, the group most likely will not tolerate the behaviors of the complex PTSD trauma clients.
In cases such as these, I have witnessed group members try to control trauma peer behaviors, and many times have requested that the trauma client leave the facility and be sent to a more suitable treatment center. This is yet another abandonment experience for the complex PTSD client which causes more harm than help.
Treating Trauma Clients
A treatment center can adequately serve even the most severely affected trauma clients with a little education and preparation. The treatment center administration holds the most important role in allowing flexibility to the clinical team, which enables them to tailor treatment expectations and oversee regulations based on individual needs.
The treatment staff needs guidance and training in toleration behaviors that are common in the abandonment pathology. For example: the “push and pull” where the client tries to push the staff away emotionally just to check if they are willing to commit to the relationship.
Once the client trusts the treatment staff, boundaries can be set. These boundaries must make sense to the client in a way that they understand the parameters are created for everyone’s safety – explained in a way that they are personal and meaningful to the client. The client must always be treated with respect and with transparency.
When the client is acting out, a professional must remember that this is a form of communication that has been developed through years of living in chaotic environments. These behaviors do not change immediately just because the treatment team puts forth their best efforts by using standardized procedures. The client needs education, compassion, treatment tailored to their individuality, and validation.
These clients are brave, and their brave acts warrant validation.
Trauma Informed Care
For the past four years, of nearly 15 years experience working in this field, I have taken a special interest in trauma clients. I have witnessed many times when the complex PTSD client feels safe, in part because they are validated and understood, while receiving individualized treatment in a program that follows trauma informed care protocols.
The healing and change that follows is rapid – you could even call it miraculous! Seeing these clients exhibit emotionally freeing attitudes for the first time in years, or first time ever in some cases, coupled with newly felt feelings of peace and happiness for their success in therapy and hope for their future truly is nothing short of a miracle.
In my opinion, PTSD – and even complex PTSD – is a treatable disorder that a fully immersed client can be freed from. It takes training, and more training, and a fully invested interest from the treatment staff in the client. But when the team understands how to provide trauma competent and trauma informed treatment, results are guaranteed.
These clients who take the step to seek treatment are amazingly strong individuals who want to better themselves and they are searching for their own miracle of healing.
You can experience the satisfaction of helping guide these clients to a safe place of healing, and rejoice in their successes, by making the decision for your treatment facility to switch to trauma informed care, train the staff and individualize the therapy to ensure the best care possible for this deserving clientele.
Hanna LeBaron, LCSW