Description
Please provide an answer that is 100% original and do not copy the answer to this question from any other website since I am already well aware of this. I will be sure to check this.
Please be sure that the answer comes up with way less than 18% on Studypool’s internal plagiarism checker since anything above this is not acceptable according to Studypool’s standards. I will not accept answers that are above this standard.
No AI or Chatbot! I will be sure to check this.
Deciding on which assessment tools to use, and when, can feel like a confusing process. For example, should you screen all adolescent clients for substance use regardless of presenting problem? Should you ask about suicide in every session or only when it feels like it could be a concern?
Such questions are made murkier by the adolescent development stage itself, which is characterized by major physical changes that can lead to mood issues. These mood issues, at the surface, may appear to be signs of mental illness but could just be the natural progression of the adolescent years.
In this Assignment, you examine assessment tools that would be appropriate for adolescent clients. As you explore the tools, you may find greater clarity about their use.
TO PREPARE
Access the Online Assessment Measures link in the Learning Resources.
On that site, explore at least three different assessment tools for adolescents under the various categories. A few that you may consider are: Level 2, Substance Use, Child Age 11 to 17; Severity Measure for Depression, Child Age 11 to 17; and Severity Measure for Generalized Anxiety Disorder, Child Age 11 to 17.
Select one assessment tool that you can see yourself using in practice with adolescent clients.
Consider why you have chosen this assessment tool and its strengths and limitations.
Submit a 1 full page paper analyzing the adolescent assessment tool you have chosen:
Why did you select the assessment tool?
Why might it be especially helpful for use with adolescents?
What challenges or limitations might there be for this assessment tool?
Use the Learning Resources to support your Assignment. Make sure to provide APA citations and a reference list.
Brandell, J. R. (Ed.). (2020). Theory & practice in clinical social work (3rd ed.). Cognella.
Chapter 7, “Clinical Social Work With Adolescents and Young Adults” (pp. 123–146)
Levenson, J. (2020). Translating trauma-informed principles into social work practiceLinks to an external site.. Social Work, 65(3), 288–298. https://doi.org/10.1093/sw/swaa020
Lougheed, J. P. (2020). Parent–adolescent dyads as temporal interpersonal emotion systemsLinks to an external site.. Journal of Research on Adolescence, 30(1), 26–40. https://doi.org/10.1111/jora.12526
American Psychiatric Association. (n.d.). Online assessment measuresLinks to an external site.. https://www.psychiatry.org/psychiatrists/practice/…
Requirements: 1 Full Page Paper Times New Roman Size 12 Font Double-Spaced APA Format Excluding the Title and Reference Pages
Please provide an answer that is 100% original and do not copy the answer to this question from any other website since I am already well aware of this. I will be sure to check this.
Please be sure that the answer comes up with way less than 18% on Studypool’s internal plagiarism checker since anything above this is not acceptable according to Studypool’s standards. I will not accept answers that are above this standard.
No AI or Chatbot! I will be sure to check this.
Please be sure to carefully follow the instructions.
Please be sure to include an introduction paragraph with a clear thesis statement in the last sentence of the introduction paragraph and a conclusion paragraph.
No plagiarism & No Course Hero & No Chegg. The assignment will be checked for originality via the Turnitin plagiarism tool.
Please be sure to include at least one in-text citation in each body paragraph.
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Jill Levenson
Trauma-informed social work is characterized by client-centered practices that facilitate
trust, safety, respect, collaboration, hope, and shared power. Many agencies have adopted
trauma-informed care (TIC) initiatives and many social workers are familiar with its basic
principles, but it is challenging to infuse these ideals into real-world service delivery. This
article offers 10 trauma-informed practices (TIPs) for translating TIC concepts into action
by (a) conceptualizing client problems, strengths, and coping strategies through the trauma
lens and (b) responding in ways that avoid inadvertently reinforcing clients’ feelings of
vulnerability and disempowerment (re-traumatization). TIPs guide workers to consider
trauma as an explanation for client problems, incorporate knowledge about trauma into
service delivery, understand trauma symptoms, transform trauma narratives, and use the
helping relationship as a tool for healing.
KEY WORDS: adverse childhood experiences; childhood adversity; trauma; trauma-informed
care; trauma-informed practices
C
lients served by social services agencies
frequently have a history of childhood
trauma; therefore, it is essential that
social workers engage in intentional traumainformed practices (TIPs) (Bent-Goodley, 2018;
Substance Abuse and Mental Health Services Administration [SAMHSA], 2014). When clients are
referred for services, the focus of intervention
tends to be on immediate presenting problems
rather than on early trauma (Knight, 2015). Current circumstances, however, can intersect with
the legacy of past adversities. Thus, it is critical for
social workers to be aware of the contributions of
distant trauma to problems of daily living and how
trauma-related dynamics might manifest within
the helping relationship.
Situations that cause a person to feel extremely
threatened and powerless can create posttraumatic
stress disorder (PTSD), characterized by intrusive
thoughts, avoidance of situational reminders, negative affect, and hyperarousal (American Psychiatric
Association, 2013; Herman, 1997; van der Kolk,
2005). Early developmental trauma like child abuse
or neglect can manifest in symptomatology other
than typical PTSD; such experiences can hinder
the formation of secure attachments and effective
coping skills throughout life (Herman, 1997; van
der Kolk, 2005). These consequences of trauma
can have domino effects that bring people into
doi: 10.1093/sw/swaa020
C 2020 National Association of Social Workers
V
social welfare systems. Trauma-informed practitioners incorporate knowledge about the neurobiological and psychosocial impacts of early adversity
into their practices to ensure nonthreatening and
client-directed service delivery (Bloom & Farragher, 2013; Brown, Baker, & Wilcox, 2012;
SAMHSA, 2014). Empowerment and safety in a
healing relationship with another human are the
first steps in repairing the wounded psyche (Herman, 1997).
Although the terms ‘‘trauma-informed care”
(TIC) and ‘‘trauma-informed practice” are often
used interchangeably, ‘‘practice is more accurately
applied to clinical intervention, while care refers to
the organizational context within which services
are provided to clients” (Knight, 2019, p. 82). This
article briefly reviews the principles and components of TIC. Then, specific suggestions are offered for translating TIC principles into TIPs. A
focus is placed on using process-oriented relational
strategies to engage clients in a corrective helping
relationship.
PRINCIPLES OF A TRAUMA-INFORMED FRAMEWORK FOR SERVICE DELIVERY
According to SAMHSA (2014), TIC begins by
recognizing that childhood trauma is very common and can have conspicuous and less obvious
impacts on physical and mental health over the life
1
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Translating Trauma-Informed Principles
into Social Work Practice
2
interaction styles (Bloom, 2013; Cicchetti &
Banny, 2014; van der Kolk, 2005, 2006). Childhood trauma can impede the cohesive integration
of memory, emotions, cognitions, and coping (van
der Kolk, 2005). In a reciprocal process, traumatizing experiences inform our expectations of others,
and these expectations are then projected onto the
interpretation of future relationships (Rutter &
Sroufe, 2000). A traumagenic childhood may hinder mastery of healthy interpersonal skills—creating a cycle of eliciting the very responses that are
expected and feared (Alexander, 2013).
Adverse childhood experiences (ACEs) are a set
of developmental traumas that can produce longlasting consequences (Felitti et al., 1998). The
groundbreaking ACE study conducted by the
Centers for Disease Control and Prevention
(CDC) in the 1990s revealed that nearly twothirds of adults reported at least one form of early
adversity in their childhood homes, and 12.5 percent reported four or more (Felitti et al., 1998).
The ACE study involved 17,000 health insurance
patients with higher education and income than
the general population, and therefore the findings
underestimate rates of childhood trauma in clinical
or forensic settings and in marginalized communities (Larkin, Felitti, & Anda, 2014). The 10 ACE
items include physical and emotional abuse and neglect; sexual abuse; and growing up in a home with
substance abuse, mental illness, domestic violence,
an absent parent, or criminality (Felitti et al.,
1998). Higher ACE scores indicate a greater number of adversities and are correlated with increased
risk for a spectrum of medical conditions, mental
illnesses, and psychosocial problems later in life
(Anda et al., 2006).
ACEs represent relational trauma, characterized
by invalidation, betrayal, and attachment disruptions (Alexander, 2013; van der Kolk, 2005).
Relational trauma occurs when caregivers are simultaneously needed and dangerous or unavailable
(Steele, Boon, & van der Hart, 2016). Growing up
in a home with chronic abuse, neglect, or other
sorts of family dysfunction can introduce feelings
of powerlessness at a young age (Bloom, 2013).
Children might feel afraid, alone, unwanted,
threatened, or ignored by people on whom they
are dependent, in the very place that is supposed to
feel safest. As a result, over time, a person may
adopt coping strategies that are protective in the
traumagenic environment but counterproductive
Social Work
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span. TIC involves creating systems of care in
which emotional well-being is paramount, using
deliberate practices that facilitate trust, respect,
hope, and shared power (Bloom, 2013; Brown
et al., 2012; Harris & Fallot, 2001; Levenson,
2017; SAMHSA, 2014). Guiding principles of
TIC include safety; transparency; enhancing peer
support; collaboration; empowerment; and awareness of cultural, historical, and gender-based
trauma (SAMHSA, 2014). The cornerstones of
TIC fit well within the environmental context and
biopsychosocial framework of strengths-based social work (Knight, 2015; Kondrat, 2008; Mishna,
Van Wert, & Asakura, 2013; Saleebey, 2011;
Uehara et al., 2013).
TIC is different from trauma-specific interventions, which aim to alleviate acute PTSD symptoms and improve coping. TIC is a framework for
understanding the nexus between childhood experiences and current presenting problems. By considering early trauma as a possible explanation
when conceptualizing client behavior, the focus is
shifted away from a focus on pathology and more
toward a perspective of strength and well-being.
Negative views of current functioning can then be
reframed as survival strategies that emerged in response to early adversity.
TIC promotes healing by fostering an alliance of
human connection to build trust and resilience.
Importantly, trauma-informed workers avoid disempowering dynamics in the helping relationship
because they can be re-traumatizing (Harris & Fallot, 2001; Knight, 2015). Long before we had the
language of TIC, psychologist Carl Rogers described the need for therapists to offer authentic
and unconditional positive regard as fundamental
elements in the therapeutic encounter (Rogers,
1961). Emotional injuries require reparative relationships with helpers who follow the client’s lead
and work cooperatively to find the best path to recovery (Kuelker, 2019). Healing occurs through
shared humanity when one feels validated, understood, and valued.
TIC emphasizes a holistic understanding of clients by thinking compassionately about problematic patterns as rehearsed responses that once
helped them cope with or adapt to a threatening
environment. Trauma can disrupt neurological
and social development, contribute to emotional
dysregulation, and alter one’s sense of self and
identity, manifesting in maladaptive coping and
TRANSLATING TIC INTO PRACTICE
Life experiences play a role in the development
and maintenance of interpersonal patterns (Bloom,
2013). Clients and their behaviors are best understood within the context of their collective past
experiences. When helpers understand trauma,
they can avoid reinforcing clients’ feelings of vulnerability and disempowerment by using TIPs
(Goodman et al., 2016). TIPs incorporate knowledge of trauma into services by (a) conceptualizing
client problems, strengths, and coping strategies
through the trauma lens and (b) responding in
ways that create safety, collaboration, trust, and
empowerment. Trauma-informed case conceptualization links presenting problems to cognitive
schemas, coping skills, and attachment styles that
might have evolved in response to unresolved
trauma. By hypothesizing how early relational
trauma might be contributing to current interpersonal difficulties, the worker can then respond intentionally to produce corrective encounters. This
can be particularly challenging when working
with clients in mandated services or who present as
resistant. In the following sections are some ideas
for translating TIC into action using the core values of safety, trustworthiness, choice, collaboration, and empowerment (Harris & Fallot, 2001).
See Table 1 for examples of TIPs.
Safety
Safe Relationships. A trauma-informed assessment
can create a conundrum when trying to balance
client-determined disclosure with the need to submit documentation. Many agencies require intake
evaluations to be completed after an initial session,
but asking pointed questions about early abuse,
neglect, or family problems in a first meeting may
feel intrusive or re-traumatizing to clients (Ferentz,
2015). Assessment is an ongoing process rather
than a one-time event; workers must allow clients
time to build trust and to share information in a
way that feels comfortable. In addition to exploring earlier trauma, workers should also ask about
resilience factors and the presence of protective
and supportive people in someone’s past and present social networks.
Helping relationships must feel safe. Safe relationships are predictable, reliable, and non-shaming.
Interpersonal safety transpires when expectations
are clear and consistent, and when rules are transparent and imposed impartially. However, boundaries must also be flexible enough to respond to
unique circumstances without unnecessary rigidity
(Najavits, 2009). The social worker’s style of interaction should be genuine, nonjudgmental, and
nonthreatening, with appropriately paced discussion of traumatizing events and the meaning attached to them. These engagement strategies might
seem self-evident or already standard in clientcentered social work (Hepworth, Rooney, Rooney,
& Strom-Gottfried, 2016), but it can be challenging
to maintain an empathic presence with clients who
seem wary, guarded, angry, unmotivated, or resistant. Through the trauma lens, however, these
characteristics can be reframed as adaptive and protective reactions to feelings of vulnerability (Steele
et al., 2016).
Other clients may be inclined toward pleasing
others and become passive or dependent in response to past trauma. These clients may feel
that they do not have a right to ask questions or assert themselves with the social worker. Boundary
crossings can occur in many subtle ways due to
countertransference or overidentification with a
client. We tend to think of countertransference as
negative, but some clients may elicit in the social
worker a desire to rescue or protect (Binder &
Strupp, 1997; Teyber & Teyber, 2017). Therapy is
an intimate relationship, and workers should be
careful to maintain professional boundaries and not
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in other settings, and cognitive schemas of mistrust
or self-blame may be embedded into interpersonal
patterns (Bloom, 2013; van der Kolk, 2006; Young,
Klosko, & Weishaar, 2003).
Resilience is built through corrective relationships that help alter internalized beliefs about self and
others (Khanlou & Wray, 2014; Knight, 2015;
Shonkoff, 2016). TIC promotes healing by reinforcing self-determination and modeling effective relational skills (Bloom & Farragher, 2013). Traumainformed practitioners intentionally minimize potential for re-traumatization (SAMHSA, 2014),
which can occur inadvertently when clinicians react to client resistance or neediness with judgment,
paternalism, or rigidity (Levenson & Willis, 2019).
A TIC paradigm of service delivery views and
responds to presenting problems through the lens
of trauma. Many agencies have adopted TIC initiatives, and many social workers are familiar with
its basic principles; it is challenging, however, to
translate these ideals into real-world service delivery (Berliner & Kolko, 2016).
Social worker tries to run a counseling group with
women in substance treatment but gets frustrated with the clients’ silence and resistance to
meaningfully participate.
Safe spaces
Client in treatment after DUI is displaying distorted thinking and minimizing his drinking
problem by insisting that drinking is legal and
very common.
Client is viewed as unmotivated to change and is
confronted with his unwillingness to work the
program. Worker says, ‘‘You won’t be successful in recovery if you aren’t honest. I can’t help
you with problem you say you don’t have.”
Food assistance worker focuses only on questions
about income and assets.
Recognize that help seeking A client is applying for food assistance after losing
can be traumagenic
his job.
Choice
Avoid confrontation
The worker might give in to her own feelings of
wanting to rescue or nurture, indulging the client’s neediness.
OR
The worker might become annoyed and remind
the client about appropriate boundaries and set
rules about contact in between sessions.
The group room is a stark room with bare walls,
hard chairs, harsh lighting, and linoleum floors.
Social worker sits behind a desk typing information into a computer during the first interview,
asking client to ‘‘comply” with the assessment.
Client seems guarded and wary.
Conceptualize through the A 40-year-old client was sexually abused in childtrauma lens
hood by a trusted relative. Her parents did not
believe her, causing her to doubt herself. As a
young adult, she was raped at college, causing
her to disengage from her peers and have few
support people. The client often contacts the
worker with questions in between sessions.
Trustworthiness
Worker is told to complete an assessment within a
time frame, which requires asking many sensitive questions quickly in a first interview.
Non-TIC Approach
Table 1: Trauma-Informed Practices (TIPs)
Case Example
Safe relationships
Safety
TIPs
(Continued)
Worker says, ‘‘Addiction can be a way to selfmedicate painful emotions. I wonder if you have
mixed feelings about recovery. It’s hard to give
up coping strategies without knowing what else
to replace them with. I wonder what it feels like
for you when you consider giving up drinking?”
Worker recognizes the feelings of loss, shame, and
fear that often accompany unemployment.
Worker validates that it can be hard and scary to
find oneself in a position of needing to ask for
help, which provides hope and removes stigma.
Client’s traumas may have left her with difficulty
trusting her own instincts, and she endlessly
second-guesses her own decisions. In sessions,
the worker validates the inner conflict, explores
trauma-related dependency dynamics, and brainstorms with the client about how to avoid reenacting them in the helping relationship.
Social worker asks for some petty cash, goes to a
store, and decorates the room with some inspirational posters, throw pillows, a pole lamp with
softer lighting, and faux plants. The room feels
warm and welcoming.
Social worker sits with client, asking open-ended
questions and validating feelings, building rapport
to elicit information while allowing client to
share at his own pace.
TIC Approach
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Note: TIC ¼ trauma-informed care.
Model shared power
A group member breaches confidentiality by talking about another member outside the group.
Member is told by worker that she broke the rules
and will be discharged from the program. This
focus on rules and consequences is designed to
protect confidentiality and reinforce personal
accountability.
Using words like batterer, addict, autistic, or offender.
Social worker views client as avoiding responsibilA mother of a child with a disability seems wary
ity and unable or unwilling to provide proper
and guarded, answering with one-word
care. This leads to a recommendation for foster
responses. She seems depressed and overcare placement.
whelmed but lacks insight into the gravity of the
situation.
Reframe resistance
Labels that define or describe people based on a
single behavior or problem can reinforce negative self-narrative and identity.
A client’s children were removed from her care
after it was learned that her husband sexually
abused them. As an undocumented person
whose husband had threatened to have her
deported if she went to police, she said she felt
that her best option was to try to protect the
kids herself within the home.
Empowerment
Use person-first language
Worker says, ‘‘I can see you are really angry right
now, and I want to understand why. Would you
be willing to sit down for two minutes and try to
help me understand what happened in your class?
I don’t want to see you get in trouble. Can you
take a few deep breaths?”
TIC Approach
Worker brings that member back into the group to
process the breach. Worker coaches the group to
discuss their feelings about the violation of privacy and explore how to handle the problem.
This builds skills for empathy, healthy communication, and problem solving.
Put the person first: Refer to clients as a person
who abused their partner, a person struggling
with addiction, someone on the spectrum, or an
individual who has been convicted of a crime.
Social worker acknowledges the loss and stress of
parenting a child with special needs. Worker
wonders if mother’s ‘‘resistance” is based on past
negative experiences with workers who seemed
judgmental and shame about her own perceived
failings as a mother.
Mother was viewed as failing to protect and told
The social worker validated the impossible dilemma
by worker that this was a naı̈ve and irresponsible
of worrying that if the client reported the abuse
response to the problem. Worker said, ‘‘You
she might not be believed, and that she might be
left them at risk for being abused again.”
taken into custody, preventing her from being at
home to protect her children. Worker said,
‘‘Can you tell me more about how you viewed
your options, and how you made your decisions
about trying to keep the kids safe?”
A teenager was referred to the school social worker Worker tries to set boundaries by explaining
choices and consequences: ‘‘If you leave the
after numerous incidents of disruptive behavior
room, I’ll have to report that you are not comin the classroom. The first thing he says to the
plying with your corrective action plan. You
social worker is, ‘‘Don’t expect me to talk to
will be suspended.”
you. I don’t trust no one.” Then, he gets up to
storm out of the room, saying, ‘‘I can’t stand
this school!”
Non-TIC Approach
Table 1: Trauma-Informed Practices (TIPs) (Continued)
Case Example
Ask, don’t tell
Collaboration
Coach self-regulation
TIPs
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Trustworthiness
Conceptualize through the Trauma Lens. Traumatized people often come to services with a
history of being unable to depend on others
to be loyal, supportive, nurturing, or responsible
(Alexander, 2013). Our earliest childhood rela-
6
tionships help us establish a foundation of trust
when we receive consistent and responsive
caretaking; when these conditions are absent, attachment and intimacy with others can be undermined (Bowlby, 1988; Erikson, 1993). Relational
theories of social work propose that client patterns will be reenacted in the helping relationship,
creating a parallel process that provides an opportunity for a corrective experience (Rasmussen &
Mishna, 2018; Tosone, 2013). Due to early relational trauma, some clients may be understandably mistrustful and wary of others, including
professional helpers. A lack of trust can be adaptive—skepticism protects the client from betrayal,
which is expected based on past experiences.
Trauma-informed case conceptualization considers the role that early adversity plays in client engagement challenges.
Traumagenic conditions can lead to learned
helplessness or to proactive aggression. For instance,
self-preservation might be displayed as antagonistic
or confrontational behavior (fight response), avoidance of intimacy or self-medication (flight response),
or passive and dependent patterns with difficulties
setting boundaries (freeze response). These survival
strategies offer personal power, relief from emotional
pain, or protection, but can also challenge a worker
who is trying to establish a trusting alliance. Use of self
is a technique that workers use to experience being
in a reciprocal relationship with the client; the
worker can intentionally observe and genuinely address client patterns as they emerge (Knight, 2012).
Trust can be enhanced by transparency and healthy
boundaries, helping the client to reach a more
desirable outcome through modeling and corrective
interactions (Teyber & Teyber, 2017; Tosone,
2013).
Circumstances that bring clients into mental
health systems are often rooted in past trauma, although other presenting problems are identified as
the reason for initiating services (Knight, 2019). For
instance, depression, anxiety, low self-esteem, relationship conflict, parenting concerns, employment
problems, or difficulties dealing with stressors can
all stem from unresolved trauma (Ferentz, 2015).
Trauma symptoms can masquerade as presenting
problems, and wounded attachments can manifest
in troubled relationships or maladaptive coping
strategies (Bloom, 2013). Ultimately, the worker
can use trauma-informed case conceptualization to
make connections between past adversities and
Social Work
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enable dependence when clients seem needy or
lack confidence in themselves. Interpersonal safety
can be enhanced by therapist authenticity and clear
relational boundaries (Covington, 2007; Tosone,
2013).
Create Safe Spaces. Clients need both physical
and psychological safety to exist from the initial
point of contact (Bloom & Farragher, 2013; Brown
et al., 2012). Call centers or hotlines should be
staffed with pleasant and comforting voices that calm
the anxiety of reaching out for help. Robotic telephone menus and automated responses, while efficient, can feel frustrating and cold without personal
connection. When a receptionist or practitioner
smiles and greets a client by saying, ‘‘We are glad
you are here,” a welcoming and engaging atmosphere is projected. Many of our clients’ experiences
have left them feeling demeaned, judged, vulnerable, or invisible; they might have also encountered
disdain or contempt from professional helpers.
When emotional safety is created from the point of
entry, clients feel valued and less intimidated (Elliott,
Bjelajac, Fallot, Markoff, & Reed, 2005).
Physical comfort and safety can be facilitated in
innovative ways. Ideally, clients walk into a waiting room that is clean and welcoming, as opposed
to one that is dingy, where toys are broken or dirty,
or where furniture feels hard and institutional. A
warm entry space creates a sense of serenity and
sends the message: ‘‘Your comfort is important to
us, because you are important.” Padded seating
made of material that can be easily cleaned is more
comfortable than hard chairs, but still within a reasonable budget. Muted colors can be more soothing than stark white walls. Artificial plants and
inspirational posters can be a way of softening a
waiting room to feel warm and friendly. Hazards
or risks within the physical environment can be
minimized with proper lighting, disability accommodations, maintenance of the property, and security safeguards. All these strategies come together
to offer a single message: ‘‘This is a comfortable environment and we won’t let bad things happen
here.”
Choice
Avoid Confrontational Approaches. Confrontational methods are commonly found in programs
for addictions, interpersonal violence, or mandated
services, and are purportedly used to promote client
accountability and challenge cognitive distortions
that justify undesirable behavior (Levenson & Willis, 2019). Recognizing and altering flawed thinking
are important goals of behavioral change (Miller
& Rollnick, 2012). Confrontation in the service
environment, however, can reactivate hyperarousal
and replicate disempowering dynamics. When clients
are confronted in ways that seem adversarial or
threatening, a defensive posture emerges, paradoxically bolstering the client’s own unhelpful ideas.
When clients perceive workers as judgmental,
shame and fear can be stimulated, rupturing the
therapeutic alliance and inhibiting clients from being forthcoming (Binder & Strupp, 1997; StreeckFischer & van der Kolk, 2000). Instead, active listening and nonthreatening methods like motivational interviewing (Miller & Rollnick, 2012) can
minimize the need for defensiveness, allowing
clients to safely explore problems and solutions, accept feedback, and improve interaction skills. For
instance, if a mandated client arrives consistently
late for sessions, instead of simply confronting the
tardiness, reminding about rules, or implementing
consequences, the worker could inquire about
why it is difficult to get there on time and explore
mixed feelings about being in therapy.
Consumers of services have the right to selfdetermination (National Association of Social
Workers [NASW], 2017), and choice involves authentic informed consent. Clients should clearly
understand the risks and benefits of engaging in
treatment (or not) and the limits of confidentiality
so they can make informed decisions about selfdisclosures. As well, choice can include asking
consumers how they would like to be referred to
(‘‘What is your preferred pronoun?”) and allowing
them to prioritize service planning goals (‘‘The
court requires this program, but what do you want
to work on?”), which enables an internal locus of
control.
Coach De-Escalation, Self-Regulation, and Relational Skills. Trauma-responsive workers pay attention to process over content so that the helping
relationship becomes a tool for improving relational and self-regulatory skills (Knight, 2015;
Pearlman & Courtois, 2005; Tosone, 2013). Attending to parallel process and use of self allows the
social worker to respond to relational themes as
they are replicated in the therapeutic encounter
(Knight, 2019; Teyber & Teyber, 2017). In other
words, the relationship with the social worker will
undoubtedly parallel the client’s other relationships, re-enacting the self-narrative and projecting
expectations onto the current interaction. The social worker must internally attend to the experience of being in a relationship with the client to
avoid re-creating dynamics similar to those in
past traumagenic relationships (Arnd-Caddigan &
Pozzuto, 2008). When the social worker can re-
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current functioning and then purposefully generate corrective strategies for intervention. Treating
everyone with kindness and respect is crucial in
building trust and interpersonal safety. It is simple
but not always easy.
Remember That Help Seeking Itself Can Be
Traumagenic. Seeking or accepting help from a
social worker can be tough for clients who have
learned not to trust others (Bloom, 2013). A personal crisis can leave a client feeling powerless or
scared, reactivating old feelings of traumatic stress.
Help seeking itself can produce feelings of vulnerability, hyperarousal, or dysregulation (Ferentz, 2015;
Pattyn, Verhaeghe, Sercu, & Bracke, 2014). When
the autonomic nervous system is in survival mode,
clients may present as either agitated or detached,
which can be misinterpreted by workers as resistance
or lack of motivation.
To those who grew up in abusive or neglectful
homes or chaotic communities, asking for help can
seem futile or even dangerous. Thus, many clients
enter our service systems with apprehension.
Some clients are embarrassed to need help, which
is reinforced if they encounter worker judgment or
condescension. Social work bureaucracies have
the potential to be oppressive and disempowering,
so we want to create a therapeutic milieu that
avoids moralistic or paternalistic authoritarianism
(Bloom, 2013). We should also be cognizant of the
many ways our clients have had limited voice and
choice in their lives. This is especially true of the
historical and cultural trauma commonly experienced by impoverished, minority, stigmatized,
and marginalized groups (SAMHSA, 2014). Social
workers can provide hope that, perhaps for the first
time ever, there is more to be gained than lost by
relying on others for help.
8
for five minutes, take some deep breaths, and try to
help me understand what is upsetting you?”).
Collaboration
Ask, Don’t Tell. Perhaps the most important thing
we can do to empower clients is avoid giving
advice. This can be challenging, especially when
clients are stuck or seem prone to repeating what
we perceive to be poor choices. Social work engagement skills emphasize active listening and
open-ended questions (Hepworth et al., 2016).
This translates to a process by which workers listen
with curiosity and compassion. Therapeutic engagement begins with conveying that the worker
is interested in understanding the client’s unique
experience and perspective. This may seem like
standard practice, but from the trauma perspective,
it involves an intentional effort to make sure clients
feel respected, valued, important, and involved:
‘‘I’m really interested in getting to know you and I
need your input!”
By asking questions, we collaborate with our
clients to define their own goals and the means
for achieving them. When clients are empowered
to view their problems as manageable and their
goals as realistic, we offer hope that the selfimprovements they desire are possible. By asking
rather than telling, we honor autonomy and selfdetermination, which allows the client to prioritize
goals and evaluate options in a meaningful way
(Saleebey, 2011). The worker becomes a coach,
partnering with the client to model planning
and decision-making skills while allowing the client to direct the process. This fosters the empowerment that is crucial in TIC and avoids the retraumatization that can occur when social workers
are authoritarian.
Reframe Resistance. Through the trauma lens,
client problems are viewed as coping strategies that
may stem from surviving a traumagenic childhood,
and workers can begin by asking, ‘‘What happened
to you?” instead of ‘‘What’s wrong with you?”
(SAMHSA, 2014). Clients’ schemata
