Welcome to the Autumn edition of Blue Knot Review, an electronic journal chronicling recent developments and new perspectives around complex trauma and trauma-informed practice.
IDENTIFYING AND TREATING COMPLEX TRAUMA-RELATED DISSOCIATION:
NEW BLUE KNOT GUIDELINES COMING SOON
Dissociation – in simple terms `the deficiency of internal and external awareness’[1] – means not paying attention and `not being present’. We cannot `stay present’ all the time due to multiple stimuli. Divided attention, performing some tasks without conscious awareness, and activities such as daydreaming and `highway hypnosis’ might be regarded as mild forms of dissociation. But dissociation can also be a response to trauma. And if dissociation is persistently activated for defensive purposes – as in the context of overwhelming childhood experiences – it can become the `default’ response around which the mind organises.[2] The prevalence of childhood trauma, and its impacts on adult health if the trauma is not resolved, means that trauma-related dissociation is common. Research upholds that dissociation is transdiagnostic and correlated with a range of adverse and often severe health impacts.[3] Yet `[o]ne characteristic of dissociative phenomena is how frequently they are misdiagnosed or not accounted for at all’.[4] It is also the case that `[m]any people in the mental health profession do not know what dissociation looks like or how to assess for it’.[5] To assist with the process of identification and appropriate treatment, Blue Knot has produced a new set of guidelines - Practice Guidelines for Identifying and Treating Complex Trauma-Related Dissociation – which complement the recently released and updated Practice Guidelines for Clinical Treatment of Complex Trauma (2019). The latter (general 2019 clinical) guidelines include substantial new material on the topic of dissociation. But the complexity of trauma-related dissociation,[6] and the many forms in which it can present,[7] also mean that it is necessary to address it in more detail. Hence Blue Knot’s release of the new Practice Guidelines for Identifying and Treating Complex Trauma-Related Dissociation which should be consulted in conjunction with the updated 2019 clinical guidelines. American psychiatrist David Spiegel notes that while `[o]ur mental life is full of discontinuities…For some, the cracks in identity are marked’.[8] The advantages of a `continuum’ model of dissociation are discussed in Ch.1 of the new complex trauma-related dissociation guidelines. Chapter 2 (`Dissociation as default: Childhood legacies, structural dissociation, and unintegrated
parts’) addresses the pathways to more severe forms of dissociation generated by adverse and overwhelming childhood experience. Lack of validation and/or inconsistent caregiving are notable in this context i.e. in addition to trauma and abuse with which they may co-occur. Disconnection pertains to self, different components of self-states, behaviour, and sense of reality:[9] `Regardless of its extent, pathological dissociation always implies processes of multiple disconnection in self-experience’.[10] Also discussed in chapter 2 is structural dissociation, which applies to divisions of the
personality which are unintegrated due to early and severe developmental trauma (of which Dissociative Identity Disorder, DID, is the most severe form). The theory of structural dissociation elaborated by Van der Hart, Nijenhuis and Steele[11] is now corroborated by neuropsychological studies which reveal different patterns of brain activity for the contrasting states.[12] These findings are `inconsistent with the idea that DID is caused by suggestion, fantasy proneness, and role playing’.[13] Chapter 2 of the new
guidelines on dissociation concludes with discussion of the `Trauma Model’ vis-a-vis the sociocognitive or `Fantasy Model’, noting that available evidence supports the former not the latter. Also noted are research findings on memory, which is now known to be non-unitary. The differences between explicit (i.e. conscious, verbal) and implicit (largely non-conscious and non-verbal) memory need to be clearly understood.[14] Chapter 3 (`A Healthy Defence Gone Wrong’:[15] Unintegrated self-states (`parts’) and DID’) presents the `state’ theory of
personality proposed by Frank Putnam.[16] It defines personality as `the collective dynamics of a person’s set of identity, emotional, and behavioral states’.[17] This is in contrast to theories which see personality as `a set of fixed, persistent, and globally defining traits that pervade all of the person’s interactions with the world’.[18] The state theory of personality speaks to the varied ways in which we act according to context. It also assists understanding of both normal and
disrupted developmental trajectories. Research upholds an association between the age of onset of traumatic experience, its duration, intensity, `and the severity of trauma-related psychopathology’.[19] In the case of the most severe outcome of childhood trauma, Dissociative Identity Disorder (DID), separate and distinct identity states `may have little or no awareness of each other and thus often behave in conflicting, contradictory, and self-defeating ways’.[20] Noting the evidence which supports the effectiveness and benefits of treating dissociative disorders, including DID, chapter 3 also presents principles to
assist clinical work when developmental pathways have been disrupted, `normal multiplicity’ has been derailed, and diverse, rigid, and dissociated self-states have been generated. Therapists are advised that treatment of DID should not be undertaken in the absence of knowledge and expertise in this area.[21] Yet helpful material for clinicians who seek to develop their ability in these regards is now increasingly available and is also presented. Appendices which summarise key features of complex trauma and dissociation and basic principles of self-care, together with a Reference list and Glossary, are also provided. As Spiegel notes in the American Journal of Psychiatry, the integration of dissociation into the
field of mental health is long overdue.[22] And as other clinicians and researchers of complex trauma affirm, `[d]issociative disorders are so common that it is essential for therapists to have undergone the trainings required for treating them; their prevalence is such that they cannot be left to a few specialists’.[23] Practice Guidelines for Identifying and Treating Complex Trauma-Related Dissociation will be available for purchase and free download within the next two months at the following link from which the 2012 Practice Guidelines for Treatment of Complex Trauma and Trauma Informed Care and Service
Delivery, updated 2019 clinical and also complementary guidelines to the 2019 clinical guidelines can now be accessed.
https://www.blueknot.org.au/resources/Publications/Practice-Guidelines References Danylchuk, L. & Connors, K. (2017) Treating Complex Trauma and Dissociation: A Practical Guide to Navigating Therapeutic Challenges Routledge, New York.
Fisher, J. (2017) Healing the Fragmented Selves of Trauma Survivors: Overcoming Internal Self-Alienation Routledge, New York.
Forner, C.A. (2017) Dissociation, Mindfulness and Creative Meditations: Trauma Informed Practice to Facilitate Growth Routledge, New York.
Guidelines for Treating Dissociative Identity Disorder in Adults, 3rd Revision, International Society for the Study of Trauma and Dissociation, Journal of Trauma & Dissociation, 12:2, 2011, 115-187
https://www.isst-d.org/wp-content/uploads/2019/02/GUIDELINES_REVISED2011.pdf
Loewenstein, R.J. (2018) `Dissociation Debates: everything you know is wrong’, Dialogues in Clinical Neuroscience, 20, 3, pp.229-242. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6296396/
Practice Guidelines for Clinical Treatment of Complex Trauma (2019) Blue Knot Foundation.
https://www.blueknot.org.au/resources/Publications/Practice-Guidelines
Practice Guidelines for Identifying and Treating Complex Trauma-Related Dissociation (2020) Blue Knot Foundation.
Putnam, F.W. (2016) The Way We Are: How States of Mind Influence Our Identities, Personality and Potential for Change (International Psychoanalytic Books [IPBooks], New York.
Rydberg, J.A. (2017) `Research and Clinical Issues in Trauma and Dissociation: Ethical and Logical Fallacies, `Myths, Misreports, and Misrepresentations’, European Journal of Trauma and Dissociation (1), pp.89-99.
Schimmenti, A. & Caretti, V. (2016) `Linking the Overwhelming with the Unbearable: Developmental Trauma, Dissociation, and the Disconnected Self’, Psychoanalytic Psychology (33, 1), pp.106-128. Schlumpf, Y., Reinders, A. et al. (2014) `Dissociative Part-Dependent Resting-State Activity in Dissociative Identity Disorder: A Controlled fMRI Perfusion Study’ PLoS One, 9(6) 10.1371/journal.pone.0098795
Schwarz, L., Corrigan, F. et al (2017) The Comprehensive Resource Model: Effective Therapeutic Techniques for the Healing of Complex Trauma Routledge, New York.
Silberg, J. (2013) The Child Survivor: Healing Developmental Trauma and Dissociation Routledge, New York.
Spiegel, D. (2018) `Integrating Dissociation’, American Journal of Psychiatry (175:1), pp.4-5.
Stavropoulos, P. & Kezelman, C. (2018) The Truth of Memory and the Memory of Truth: Different Types of Memory and the Significance for Trauma (Blue Knot Foundation, Sydney)
https://www.blueknot.org.au/resources/publications/trauma-and-memory
Steinberg, M. & Schnall, M. (2003) The Stranger in the Mirror (HarperCollins, New York).Van der Hart, O., Nijenhuis, E. & Steele, K. (2006) The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization, Norton, New York. CITATIONS [1] Christine A. Forner, Dissociation, Mindfulness and Creative Meditations (Routledge, New York, 2017), p.xii.
[2] Joyanna Silberg, The Child Survivor: Healing Developmental Trauma and Dissociation Routledge, New York, 2013). Note that `[s]evere disruptions in the early development of attachment patterns between children and their caretakers seem to be precursors of dissociative pathology, including more complex structural dissociation of the personality’ (Onno van der Hart, Ellert Nijenhuis & Kathy Steele, The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization, Norton, New York, 2006, p.85.
[3] `DDs are common in general and clinical populations and represent a major underserved population with a substantial risk for suicidal and self-destructive behavior’ (Richard J. Loewenstein, `Dissociation Debates: everything you know is wrong’, Dialogues in Clinical Neuroscience, 20, 3, 2018, p.229).
[4] Lynette Danylchuk & Kevin Connors, Treating Complex Trauma and Dissociation: A Practical Guide to Navigating Therapeutic Challenges (Routledge, New York, 2017), p. 39.
[5] Danylchuk & Connors, Ibid.
[6] `Whereas continuous consciousness across states might be typical of complex PTSD, development of increasingly severe trauma-related disorders…increasingly becomes a risk the more prolonged and severe the traumatic events’ (Janina Fisher, Healing the Fragmented Selves of Trauma Survivors, Routledge, New York, 2017, p.67).
[7] Dissociative splits `can range from very simple to extremely complex divisions of the personality’ (van der Hart et al, The Haunted Self, ibid, p.5.
[8] David Spiegel, `Integrating Dissociation’, American Journal of Psychiatry (175:1, 2018), p.4.
[9] Adriano Schimmenti & V. Caretti, `Linking the Overwhelming with the Unbearable: Developmental Trauma, Dissociation, and the Disconnected Self’, Psychoanalytic Psychology (33, 1, 2016), p. 120.
[10] Schimmenti & Caretti, `Linking the Overwhelming with the Unbearable…’, ibid.
[11] Van der Hart, Nijenhuis & Steele, ibid.
[12] Yolanda Schlumpf, Antje Reinders, et al. `Dissociative Part-Dependent Resting-State Activity in Dissociative Identity Disorder: A Controlled fMRI Perfusion Study’ PLoS One, 9(6) 2014 10.1371/journal.pone.0098795
[13] Schlumpf, Reinders, et al. `Dissociative Part-Dependent Resting-State Activity in Dissociative Identity Disorder: A Controlled fMRI Perfusion Study’, ibid.
[14] See The Truth of Memory and the Memory of Truth: Different Types of Memory and the Significance for Trauma (Blue Knot Foundation, Sydney, 2018)
https://www.blueknot.org.au/resources/publications/trauma-and-memory
[15] Marlene Steinberg & Maxine Schnall, The Stranger in the Mirror (HarperCollins, New York, 2003), p.8.
[16] Frank W. Putnam, The Way We Are: How States of Mind Influence Our Identities, Personality and Potential for Change (International Psychoanalytic Books [IPBooks], New York, 2016
[17] Putnam, The Way We Are, ibid. p.159.
[18] Putnam, The Way We Are, ibid.
[19] Jenny Ann Rydberg, `Research and Clinical Issues in Trauma and Dissociation: Ethical and Logical Fallacies, Myths, Misreports, and Misrepresentations’, European Journal of Trauma and Dissociation (1, 2017), p.95.
[20] Putnam, The Way We Are, ibid, p 159.
[21] Also note that dedicated treatment guidelines for DID differ from the clinical guidelines for treatment of complex trauma. See Guidelines for Treating Dissociative Identity Disorder in Adults, 3rd Revision, International Society for the Study of Trauma and Dissociation, Journal of Trauma & Dissociation, 12:2, 2011, 115-187
https://www.isst-d.org/wp-content/uploads/2019/02/GUIDELINES_REVISED2011.pdf
[22] Spiegel, `Integrating Dissociation’, ibid.
[23] Lisa Schwarz, Frank Corrigan, et al The Comprehensive Resource Model: Effective Therapeutic Techniques for the Healing of Complex Trauma (Routledge, New York, 2017), p.227.
A Discussion with
Dr Cathy Kezelman AM
on the Wellbeing of Government Staff
We recently sat down with Dr Cathy Kezelman AM, President of the Blue Knot Foundation, as she looks into the key issues that the Government needs to be aware of to ensure the wellbeing of their staff. She will be presenting at the upcoming 6th Annual Government Law Conference 2020 on Wednesday 11 March, where she will delving into how Government lawyers can safeguard their wellbeing in challenging times.
What are some of the key issues for Government to ensure the wellbeing of staff?
These are challenging times politically not just in Australia but also globally. It is a time of escalating stress as the pace of daily life speeds up and technology arguably offers as many challenges as it does opportunities. It can also be a time of uncertainty with job changes and restructures as government seeks to respond to the rapid pace of change externally, and tight fiscal times.
Change is challenging for us all and the uncertainty which accompanies change can impact the health and wellbeing of staff within government. The environment of uncertainty together with that of time pressure and budget demands is one of escalating stress. While work/life balance has always been somewhat elusive in many work roles, in the current day, despite flexible work practices, many people find balance difficult to sustain. The ability to achieve it depends on not only the individual and their attention to their own self-care but also to team and organisational culture. With changing environments and constantly changing teams and culture it can be hard for staff to know where to turn if they find their sense of wellbeing is waning.
What is not being understood about stress and trauma and its impacts on government staff if left unmanaged?
Research (neuroscience) helps us understand how stress affects our body and brain. When we are in danger or think we are, our body switches to automatic. Our thinking brain switches off and our stress response takes over. Our stress response is a survival response. It is part of our biology. It helps us survive danger. It is innate – biologically ‘built in’ and happens outside of our conscious awareness.
When responses are innate, we do not intend them. They simply ‘cannot be helped’. We survive in one of three main ways. We fight, we run away (flee) or we freeze (shut down). When we are in fight or flight, we become agitated (on high alert). We call this hyperarousal. When we freeze, we shut down, go numb or dissociate (i.e. we disconnect from our current experience – this is not conscious). We call this hypoarousal. When the danger passes, our thinking brain turns back on. Our body becomes calm. We return to a resting state. In the resting state we can repair. This happens with everyday stress.
Trauma is different. For people with trauma histories, or when are in danger, (or think we are), the stress response stays turned on. Our body and brain are flooded with stress hormones e.g. adrenaline and cortisol. When this happens, we stay in survival mode. It means that we can’t readily return to a calm state of repair. What’s more we can be triggered into this response – by cues in the environment. These can be sensory cues i.e. stimuli which activate one of our 5 senses – smell, touch, sight, hearing, taste or something which reminds us of prior trauma. Often the trigger is not obvious.
In uncertain times, and times of change and challenge there are lots of triggers for many of us, including a felt sense of danger, threat and powerlessness. This can mean we are anxious and on edge or shut down at other times. It can be hard for us to manage often strong emotions and the effects they have on our equilibrium and relationships.
What are the growing risks and trends for government with staff burnout and increase incidents of vicarious trauma?
Vicarious trauma is a risk for anyone who is exposed to trauma material or with people with trauma experiences. It is not a matter of personal weakness. It is to be expected. The effects of vicarious trauma are similar to those of Post-traumatic stress disorder (PTSD). This can include intrusive symptoms e.g. flashbacks, nightmares; constrictive symptoms e.g. numbing and dissociation and avoidance (of people or prior trauma). It also can include changes in thoughts (cognitions) as well as a disruption of core beliefs and a person’s world view. Vicarious trauma can also affect a person’s feelings of safety, trust, self-esteem, meaning and hope as well as their relationships.
Vicarious trauma develops as a result of exposure to traumatic material over time. While it develops only because of exposure to traumatic material, it can be affected by other factors. These include a person’s work context and workload, their existing coping strategies and different factors in the service or system in which they work. The main challenge with vicarious trauma is recognising and managing it. It is progressively being seen as a Work Health and Safety issue.
Workers who have supported traumatised people can grow beyond the trauma and develop a renewed identity, world view and priorities. Acknowledging and embracing the impact of VT or other impacts can become a source of resilience.
Burnout is different. It can be experienced by any worker in any workplace. It is not about working with trauma material. Rather it reflects the general stressors in the workplace (Brown, 2009). Burnout presents as physical and emotional exhaustion. Compassion fatigue is the emotional impact of helping others. This can happen without trauma exposure e.g. aged care workers. This used to be called secondary traumatic stress.
It is hard to know whether there is an increase in burnout and vicarious trauma in the workplace or whether it is about greater recognition. In respect to both burnout and vicarious trauma the important thing is to be aware of the issues, recognise them early and implement strategies to mitigate them. They both don’t only affect worker wellbeing but also productivity and job satisfaction and longevity.
Are there any specific strategies that can be implemented by government departments to counteract the impacts in the workplace?
All government departments need to invest in the health and wellbeing of their staff. This means that there needs to be clarity of roles and responsibilities, open and transparent communication around change and reasonable expectations around workload. It is also important to vary work tasks especially for people who are dealing with trauma material. Variety as well as scheduled breaks are important. So too are robust feedback mechanisms in the spirit of open collaboration and team cohesion.
The culture is important too. This means a culture in which there is an openness to hearing of staff members who might be struggling with their workload or the nature of their work. It means having teams which invest in wellbeing practices and provide support to those who are feeling impacted. It is important for government departments to invest in ongoing trauma-informed and vicarious trauma training. Workshopping the strategies needed, putting wellbeing plans in place and building in support structures, including formal and informal debriefing, mentoring and supervision are critical. These are OH& S issues and emotional and physical health and wellbeing are no longer just the responsibility of the worker and their daily self-care plan. It is about systems change and a culture of flexible receptive work practices for all.
Working in the AOD Sector with People Experiencing TraumaBy Dr Cathy Kezelman AM President of Blue Knot Foundation—National Centre of Excellence for Complex Trauma
More than five million Australian adults have experienced interpersonal trauma (i.e. trauma between people). When interpersonal trauma is repeated, extreme and ongoing, it is called complex trauma. Complex trauma can occur from events in childhood, as an adult or both. Statistics suggest that between two-thirds and three-quarters of people seeking services for AOD issues have a lived experience of trauma, often complex trauma from childhood. Many people struggle with complex trauma impacts, mental health issues and AOD use. Yet traditionally each element has been approached in a compartmentalised way. Trauma informed care is an approach which recognises that most people seeking services are living with the effects of overwhelming life experiences. This includes people seeking AOD services. Trauma informed services depend on ‘a
thorough understanding of the profound neurological, biological, psychological and social effects of trauma and violence on the individual and an appreciation for the high prevalence of traumatic experiences in persons who receive mental health and addiction services’.¹ A trauma informed approach recognises that services designed to support survivors can also be triggering and potentially re-traumatising. This is why trauma informed training is needed across all sectors, including the AOD sector to support understanding and the skill development around complex trauma related issues. Bibliography 1. Jennings, A. (2004). Models for developing trauma informed behavioural health systems and trauma
specific services. Rockville, MD: United States Department of Health and Human Services. NADA Advocate Issue 1: March 2020
https://www.nada.org.au/wp-content/uploads/2020/03/nada_advocate_2020_march.pdf
National Counselling and Referral ServiceSupporting people affected by the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability (Disability Royal Commission) This new service delivered by Blue Knot Foundation and funded by the Federal government opened its doors on 17 October 2019.
The Disability Royal CommissionThe Disability Royal Commission was established on 4 April 2019 and will run for three years. It will look at ways to protect people with disability from experiencing violence, abuse neglect and exploitation. To find out more about the Commission visit the Disability Royal Commission’s website. Counselling support and referralsBlue Knot Foundation has established a specialist service to provide counselling support and referrals for people with disability, their families and carers, and anyone affected by the Disability Royal Commission. This service operates from: - 9am-6pm AEST Mon-Fri and
- 9am-5pm AEST Sat, Sun and public holidays.
Our counsellors can be contacted on 1800 421 468. This is a separate service from the Blue Knot and Redress Helpline which provides counselling, support, information and for support around the National Redress Scheme. Who the service is for: - people with disabilities who have experienced violence, abuse, neglect and exploitation anywhere
- parents, guardians, other family members of a person with disability
- carers of a person with disability
- advocates for people with disability
- service providers or agencies working with people with disability
- employers or colleagues of a person with a disability
What the service provides: - professional short-term counselling and support
- a gateway to frontline counselling services
- warm transfers to and from the Royal Commission, advocacy and legal support services
- information and referrals
about other useful services
- psychoeducation
Blue Knot Professional Supervision and Consultancy
Blue Knot Foundation is an established provider of external supervision with highly experienced and qualified supervisors.
In the current climate Blue Knot continues to reflect upon how best we can support our community through this period of environmental change.
FOR TEAMS
Our Reflect and Relate Sessions are designed specifically for practitioners to have space as a team to unpack some of the impacts of working in a remote setting without physical contact. The sessions offer a critical opportunity to create connection and gain emotional and practical support for your team.
The focus will include:
a) Holding the space – how to support your team when working with clients remotely.
b) Isolation and the impacts – strategies to support teams and individuals – grounding and connection
c) Managing Risk and Relationship – when unable to physically support clients or discern the real risks to families
d) Staff Wellbeing – Managing the unknown and the potential feelings of powerlessness
e) Understanding trauma-informed practice in this context This of course all unpacks some very real and potential vicarious trauma impacts occurring for organisations at present. Building awareness and implementing strategies to support staff is vital.
To book your team sessions or find out more contact us via our enquiry form or email supervision@blueknot.org.au We look forward to continuing our support of you and your organisation throughout these challenging times.
FOR PRACTITIONERS
Our Individual Counselling Sessions are for practitioners who would like some additional emotional support. Often our needs as a worker can be de-prioritised and stress can build and trigger other parts of our lives. When crises come this can further impact and ignite feelings and memories that have laid dormant. Blue Knot would like to offer a space to practitioners who would like additional individual support throughout this time, wherever you are in the world.
Blue Knot has experienced therapists who can provide one-on-one virtual sessions on Zoom to provide support and stability during these unpredictable times. To create a secure base for your clients, you must first create a sense of safety for yourself. Our Individual Supervision Sessions are also still available as per our normal program. These are focused on unpacking dynamics with clients and cases and the impacts of this on the self. These sessions are focused on giving strategies to support clients in the work content and to undertake reflective practice.
To book individual counselling or supervision contact the Blue Knot Foundation at supervision@blueknot.org.au
FOR ORGANISATIONS
Our Trauma-Informed Consultancy offers an opportunity in this period of reflection to review and make recommendations on your policies and procedures. If, as an organisation, you have been considering how you can implement or increase trauma-informed practice within your teams, Blue Knot can assist by providing a trauma-informed lens. Our consultants can review your documentation and/or processes and make recommendations ie: about language used, forms or ask you to consider key questions about your organisation’s approach. You can also book a consultancy session to look at your current needs and how Blue Knot can support you and your organisation. To learn more or book a consultancy session contact training@blueknot.org.au
Coronavirus (COVID-19) Fact Sheets for the Community and Health Practitioners In response to the outbreak of COVID-19 (Coronvirus), Blue Knot have prepared some fact sheets to help members of the community, as well as health professionals take care of themselves and others during this challenging time. Here at Blue Knot Foundation, we will continue to provide as many of our usual services as we can. As the health and wellbeing of our staff is our absolute priority we are rapidly transitioning our teams to working from home. We will still deliver all of our counselling services – Blue Knot and Redress Helpline as well as the National Counselling and
Referral Service supporting people affected by or engaging with the Disability Royal Commission. Our counselling services will maintain the high degree of professionalism, privacy and confidentiality currently provided. Should there be any disruptions to our services during this transitions, we anticipate that they will be minor and temporary. Our focus is for our trauma specialist counsellors to continue to provide the counselling, support and information currently provided through all the usual numbers and channels. Blue Knot will be additionally releasing new publications and fact sheets in the coming months, including resources related to caring for ourselves during the Coronavirus outbreak Download Fact Sheet for Community Download Fact Sheet for Health Practitioners
Blue Knot Review is an electronic journal chronicling recent developments and new perspectives around complex trauma and trauma-informed practice. Contact newsletter@blueknot.org.au for feedback or to contribute. Click here to subscribe or forward this email to anyone who may be interested
The Blue Knot and Redress Helpline and has established a referral database of mental health practitioners, doctors,
service providers and support groups to provide referral options to callers of our Helpline. If you are a trauma-informed health professional you can apply to be included on this referral database here.
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