This is the second part of the Anne McKechnie, Forensic Clinical Psychologist, Tomorrows Women Glasgow article which first appeared in the Scottish Justice Matters blog.
Establishing trust is the key beginning to work in a trauma-informed way. Engaging the women with our service involves frequent phone calls, text messages, home visits and close liaison with other agencies. When our clients are reluctant to engage, the temptation is to say that the woman is “not willing to engage” or “more interested in taking drugs or offending”. Being trauma-informed, however, requires our staff to look beyond the superficial presentation and formulate that lack of engagement differently.
A recent paper by Mette Kreis showed that women with a history of substance misuse and drug-related offending exhibit high levels of shame. Shame is commonly seen in complex trauma and individuals with early histories of abandonment and neglect. When working in a trauma-informed way, we strive to understand lack of engagement as a consequence of feelings of shame. Women commonly say “I am not worth anything, why bother with me”, “Can you handle me because no one else has been able to” or “I can’t trust people; everyone has let me down”. Persistent “door knocking” challenges these core beliefs.
Trauma-Informed Practice (TIP) also prioritises staff support and training: With a high incidence of mental health need, staff often feel overwhelmed and unsure as to how to manage. The dynamics of working closely with women who have experienced rejection and stigma from an early age are often taxing. We therefore prioritise supervision for staff, provided four weekly by the team lead Anne Gallacher. In addition, we have established weekly complex case discussions and regular training sessions so that staff, even if they are not directly “treating” symptoms of Complex PTSD, develop a trauma-informed understanding of the women’s presenting problems.
In providing choice and empowering women in decision making, there is a risk that we may be seen as a “Soft option”; that attending theatre workshops or art groups and tennis lessons is seen as pure entertainment and pastime, rather than addressing offending behaviour. If one views offence-focused work as systematic exploration of offending, we are certainly not addressing offending. It can be argued, however, that we are addressing the underlying causes of crime – poor coping, use of substances to regulate disabling and overwhelming emotions, poor choice in relationships. Prison and therefore offending to get there is very attractive to someone whose experiences of care have always been met in secure settings or whose life in the community is spent in hostels and troubled by distressing memories of the past. Attending activities at Tomorrow’s Women Glasgow and building relationships with staff is the first, hardest and most important step toward addressing trauma, attachment, coping skills and, in turn, offending behaviours
Once our women have established trust with the service, they can be referred for assessment and treatment of their mental health problems, be it Complex PTSD, clinical depression, chronic anxiety or personality difficulties.
The evidence based treatment for Complex PTSD is the three stage model, first proposed by Judith Herman in her book “Trauma and Recovery”, recommends that treatment be offered in 3 stages:
- Understanding the role that trauma has played in the development of their difficulties (Psycho-education); teaching distraction and grounding techniques to help them manage flashbacks and nightmares; establishing safety in their environment; addressing the use of substances to other risky behaviours as a maladaptive way of dealing with feeling sad, lonely or ashamed.
- Talking over the actual memories to challenge and change core beliefs of shame; grieving over that which has been lost
- reconnecting with the world in building relationship and life skills
Within Tomorrow’s Women Glasgow, we aim to help the women to first of all establish safety by helping them make safer choices, developing grounding and distraction techniques with them, improving access to safer accommodation and addressing their financial health and linking into other social and health services.
The second stage involves more direct engagement with clinical psychology, where traumatic memories are explored in detail and the woman helped to change her views of the abuse; that because she was young she was not to blame, that repeatedly being abused in adult relationships was not a clear rational choice but all she felt she deserved.
Reconnecting with the world for our women has meant moving on to college, linking them with voluntary projects and Jobs and Business Glasgow and we will be training women to volunteer in this service. All of this not only fits with stage 3 of the treatment model but is core to empowering service users as recommended in TIP.
We were delighted when One Glasgow were able to provide us with statistics that showed a 42% reduction in offending amongst our women – proof that being trauma-informed can reduce offending.
Maxine Harris, Roger D. Fallot, Envisioning a Trauma-Informed
Service System: 2001
Herman, Judith “Trauma and recovery” 1992
Mette K. F. Kreis, et al
(2016) Relational Pathways to Substance Misuse and Drug-Related Offending in Women:
International Journal of Forensic Mental
Health, 15:1, 35-47