Welcome to the Summer edition of Blue Knot Review, an electronic journal chronicling recent developments and new perspectives around complex trauma and trauma-informed practice.

New Complex Trauma Clinical Guidelines Launched

https://news.isst-d.org/news-you-can-use-october-2019/ Republished with permission from Editor ISSTD News – Kate McMaugh

Blue Knot Foundation, Australia’s National Centre of Excellence for Complex Trauma has launched new clinical guidelines for the treatment of complex trauma. Written by ISSTD members, Dr Cathy Kezelman AM and Pam Stavropoulos PhD, these clinical guidelines update the original ground-breaking and internationally acclaimed clinical guidelines, which were published in 2012. 

The original guidelines were unique: the first such clinical guidelines published anywhere in the world. In fact, they were endorsed by ISSTD, the first time the organisation had ever endorsed treatment guidelines from another organisation.

Much has changed in the treatment of complex trauma since 2012, not just in Australia, but around the world. These updated guidelines expand and further develop the material written in 2012 and contain considerable new material. 

The guidelines open with a Foreword by ISSTD Past President, Professor Warwick Middleton and then unfold in two inter-related parts: Part One comprising the actual guidelines and Part Two a summary of the research behind the guidelines.

Speakers at the Launch: Prof Warwick Middleton, Mary Williams AM, Dr Cathy Kezelman AM and Bob Atkinson AO APM 

However, this quick description does not do justice to the content. This is not a document to be taken lightly, but rather an essential resource for students, clinicians and researchers from around the world. To illustrate: Part Two commences with a summary of key themes to emerge from current research. In itself, this is a useful and integrative document. Part Two is then further divided into five chapters: 

•    Chapter 1: Understanding Complex Trauma and the Implications for Treatment
•    Chapter 2: What is dissociation and why do we need to know about it?
•    Chapter 3: Revisiting Phased Treatment for Complex Trauma
•    Chapter 4: ‘New’ and Emerging Treatments
•    Chapter 5: ‘Evidence-based’: the challenge of and for complex trauma

For me, one of the most exciting aspects of these new guidelines is the increased focus on dissociation and dissociative disorders. Indeed, dissociation is front and centre of the guidelines, as is illustrated by a quick look at the actual guidelines. For example:

•    Guideline 5: Attune to dissociation and the treatment implications
•    Guideline 6: Become aware of the core dissociative symptoms of depersonalisation (estrangement from self), derealisation (estrangement from environment), amnesia, identity confusion, and identity alteration which occur in varied combinations 
•    Guideline 7: Understand that complex trauma-related dissociation underlies diverse presentations and remains widely undetected.
•    Guideline 20: Ensure that all treatment modalities are ‘dissociation informed’ as well as trauma-informed.
•    Guideline 33: Recognise that misconceptions about Dissociative Identity Disorder (DID) continue to circulate.

For many of us, used to working within a trauma field that can marginalise and even dismiss dissociation, these guidelines are a welcome relief and illustrate the extensive experience and sensitivities of the two authors. They also do justice to the unrelenting work of theorists, clinicians and researchers in the dissociation field, who have continued to produce high quality work, often against great obstacles, to build the credibility of the dissociation field.

•    Guidelines to Differences between Therapy for Complex Trauma and Standard Counselling Approaches; and
•    Guidelines to Therapist Competencies for Working with Complex Trauma and Dissociation
 

•    Guidelines to Differences between Therapy for Complex Trauma and Standard Counselling Approaches; and
•    Guidelines to Therapist Competencies for Working with Complex Trauma and Dissociation

Launch of the Guidelines

The Guidelines were launched at Belmont Hospital in Brisbane, Australia on 31 October 2019. Belmont Hospital is notable as the ‘home’ of the Trauma and Dissociation Unit (TDU) Australia’s oldest specialist inpatient service for treating complex trauma and dissociation, and still one of only a few such units in the southern hemisphere.

The launch was hugely successful. The speakers were Mary Williams AM, CEO of Belmont Hospital, Dr Cathy Kezelman AM, President of Blue Knot Foundation, Bob Atkinson AO APM, a past Commissioner of Australia’s Royal Commission into Institutional Responses to Child Sexual Abuse and Professor Warwick Middleton, Founder and Medical Director of the TDU.

Dr Cathy Kezelman, President of the Blue Knot Foundation was delighted with the event. She said, “The presence and role of Bob Atkinson, one of the prior Royal Commissioners from Australia’s ground-breaking Royal Commission into Institutional Responses to Child Sexual abuse was an added bonus. His five years with the Royal Commission, meeting with many survivors in private sessions as well as public hearings, and his compassion, humility and compassion continue to be inspiring.” 

She added, “I was delighted to represent Blue Knot Foundation and to have the chance to acknowledge the inspiring contribution of Pam Stavropoulos, our Head of Research, who did the hard yards for this publication, over an 18-month period. Pam’s passion, insights, and superior research and integrative skills provided the basis of these Guidelines.” 

ISSTD Past President Prof Warwick Middleton speaking at the launch

Dr Kezelman also acknowledged the special contribution of Past President of ISSTD, and current co-Chair of ISSTD’s Membership Committee, Professor Warwick Middleton, calling him “a driving force in the area of complex trauma and dissociation, both nationally and internationally”. She added that “Warwick is not only a member of Blue Knot’s Advisory Panel and a pre-eminent clinician, researcher and leader but an endlessly supportive advocate for people with a lived experience.”

These Guidelines have been endorsed by ISSTD and many other leaders in the field. In their endorsement ISSTD’s Board of Directors wrote: 

“The Board of Directors of the International Society for the Study of Trauma and Dissociation is pleased to endorse Blue Knot’s Practice Guidelines for Clinical Treatment of Complex Trauma. Blue Knot has provided the complex trauma field with an invaluable and accessible resource that synthesizes the rapidly expanding evidence base for the efficacious treatment of trauma and dissociation.”

Practice Guidelines 2019 
https://www.blueknot.org.au/Resources/Publications/Practice-Guidelines/Practice-Guidelines-2019

Complementary Guidelines
https://www.blueknot.org.au/Resources/Publications/Practice-Guidelines/Complementary-Guidelines

And for those interested in where this all started the original 2012 Guidelines are also still available, and particularly useful for clinicians new to the field. In fact, I recommend people have a look at these, if they haven’t already done so. They are an important part of the history of our field and comparing them to the 2019 Guidelines is in itself a mini history lesson in the evolution of our field.

Practice Guidelines 2012
https://www.blueknot.org.au/Resources/Publications/Practice-Guidelines/Practice-Guidelines-2012.

The Complementary Guidelines to Practice Guidelines for Clinical Treatment of Complex Trauma address ways in which therapy for complex trauma differs from standard counselling approaches (complementary guidelines 1) and the competencies required of therapists doing this work (complementary guidelines 2).

Both of the Complementary Guidelines supplement the main clinical guidelines in important ways. While the original and updated clinical guidelines convey what therapy for complex trauma clients entails, they do not explain how therapy for complex trauma differs from familiar but otherwise diverse counselling modalities. This is addressed in the new Guidelines to Differences between Therapy for Complex trauma and Standard Counselling Approaches (i.e. the first set of the two). The clinical guidelines also do not specify the attributes and abilities therapists need. These are addressed in the new Guidelines to Therapist Competencies for Working with Complex Trauma and Dissociation (i.e. the second set). 

In combination, these two sets of complementary guidelines within this single additional publication supplement and support the main clinical guidelines in alerting therapists to the nature of the requisite skills for working with complex trauma clients. The Guidelines to Differences between Therapy for Complex trauma and Standard Counselling Approaches address the ways in which working with clients who experience the impacts of complex trauma require adaptation of counselling principles which are common to a wide range of psychotherapies (i.e. irrespective of the particular modality). This relates not only to the need for all modalities to be trauma-informed. At a more basic level it relates to the `taken for granteds’ of what `good’ therapy is widely considered to comprise.
 
For example, many otherwise diverse counselling approaches share the principles of empathy, an orientation which is `strengths-based’, and an emphasis on the `whole person’. While such principles are valuable at a broad level, they require adaptation in the context of therapy for complex trauma. Therapists may be surprised by the extent to which `articles of faith’ which diverse modalities hold in common actually require significant amendment and supplementation for clients who experience the impacts of complex trauma and dissociation. This also relates to the key area of boundaries, the notion of the `client as expert’, and reconsideration of familiar beliefs about therapist proactivity and `over-functioning’. The new Guidelines to Differences between Therapy for Complex trauma and Standard Counselling Approaches offer a valuable corrective to common therapeutic principles which need revising when working with people experiencing the impacts of complex trauma.

Similarly, the new Guidelines to Therapist Competencies for Working with Complex Trauma and Dissociation present principles which contrast with `standard’ therapist competencies held in common by otherwise diverse modalities. For example, in a chapter titled `Changing Roles for Client and Therapist’ in the book Healing the Fragmented Selves of Trauma Survivors (2017) Janina Fisher delineates additional roles for the therapist which extend far beyond those prescribed in standard therapist trainings (`The challenges of utilizing any treatment approach effectively become greater when amnesic barriers and/or intense conflicts between parts create an inability for the whole person or system to work with the therapist, much less work with itself’; Fisher, 2017: 156). 

Both seasoned and aspiring therapists will benefit from close reading of the new `competencies’ presented in this second set of complementary guidelines. Together with the first set of recommendations on ways in which therapy for complex trauma differs from standard counselling approaches, these competencies serve as a much-needed guide to effective therapy with clients who experience the multiple impacts of complex trauma and dissociation. As such, the new Complementary Guidelines to Practice Guidelines for Clinical Treatment of Complex Trauma stand as an important publication in their own right, as well as a valuable supplement to the clinical guidelines.

To purchase or download your copy go to https://www.blueknot.org.au/Resources/Publications/Practice-Guidelines/Complementary-Guidelines
 

Blue Knot to Present at Fourth Biennial International Childhood Trauma Conference

Australian Childhood Foundation's International Childhood Trauma Conference will be held next year with the theme Connection and Healing.  Over 25 international speakers will be presenting over six days, and Blue Knot Foundation will presenting its Practice Guidelines for Clinical Treatment of Complex Trauma.

Over 10,000 delegates from around the world have participated over the last three conferences, sharing and attaining knowledge, and developing their ability to support children, young people and adults who are affected by violence, abuse and neglect.

We have a special discounted fee for Blue Knot Foundation subscribers to the 2020 International Childhood Trauma Conference. Anytime you register for the full 5 days of the conference and masterclasses, you will receive an extra $100 off the advertised rate.

Go here to register
Enter the following promotional code at checkout: CT2020 5 Day Discount

Trainers Required Nationally

Blue Knot Foundation is expanding its training arm and is looking for experienced trainers/facilitators to deliver our suite of trauma-informed and clinical packages around the country. This contract position could complement the work of professionals in private practice or who work part time in a trauma service. 

We are looking for trainers with excellent training facilitation skills, confidence, enthusiasm AND, experience and skill sets in one, or more, of the following:
1. clinical/ counselling experience working within domestic and family violence services (at least 5 years)
2. experienced complex trauma clinicians (at least 5 years) who implement best practice approaches
3. working in organisational settings which support traumatised people
4. lawyers working with people with complex trauma histories 
5. working with Aboriginal and Torres Strait Islander peoples
6. working with people who use alcohol and other drugs 
7. working within homelessness services
8. carers of adults who have been repeatedly traumatised
9. working with people with different abilities / disability
10. people managers (with at least 5 years people management experience) working in human services, health or other services that provide services to traumatised people
11. working in educational settings with adolescents or adults who have been traumatised
12. provision of clinical supervision to complex trauma practitioners.     

We are looking for trainers in all Australian States and Territories.  If you are interested or know someone that might be suitable please go here for more information.

It explores how all forms of psychotherapy, themselves diverse, enhance neuroplasticity and the capacity for repair – as a result of new experiences and relationships. New material on altruism, executive functioning, the relationship between cognition and emotion, trauma and change round out this essential book.

Louis Cozolino, PhD, is professor of psychology at Pepperdine University and a clinician in private practice.

Reviews

“There is no doubt that psychotherapists would benefit from understanding the neurobiology underpinning their interaction with patients. . . . [T]his is a ‘must read’ for psychotherapists of the 21st century.”
- British Journal of Psychiatry

“Beautifully organized and artfully presented, Cozolino provides an expansive and insightful account of the neuroscience that transpires between two individuals on a healing journey and why this neuroscience cannot be ignored.”
- Psych Central

Go here to purchase the book from Booktopia 

Blue Knot Professional Development Training

Calendar February - March 2020

Bookings are now open for our 2020 training programs.  Blue Knot Foundation’s training programs foster the knowledge, skills and tools you need to empower recovery with your trauma clients, with a focus on complex trauma clients.

Blue Knot’s trauma training is informative, interactive and engaging. It is facilitated by experienced clinicians and trauma trainers around Australia. Blue Knot delivers 1/2, 1 and 2 day programs. We can also tailor our training and services to meet the needs of your organisation and staff.

Go here to find out more, email trainingandservices@blueknot.org.au or call 02 8920 3611 to speak to a member of our training team.

Reader Contribution

Murdered Before We Die - Mark Stiles

It was minus 1 degree.  The winters in Goulburn where amazingly cold with a sensation that your very bone marrow was freezing; and it became doubtful that sunshine would ever restore heat and feeling to us.  I often woke and looked around in the gloomy dormitory I shared with 30 something other boys.

Some beds where quiet and still, others had an almost unperceivable yet deeply disturbing whimpering sound coming from them – akin to a badly beaten puppy.  Other beds contained boys who had wet their beds earlier in the evening, usually out of fear and terror, and knew that they would have to spend the night lying in a wet bed or suffer the consequences of waking up an officer to get clean and dry bedding.  

From time to time an officer would navigate his way around the gloomy room looking for a victim to strike out against.  Other times he would stand at the door and bark out a name to get out of bed and front and centre to the doorway of the dormitory, to be taken downstairs and punished for a made up crime of the day.  You never knew whose turn it was next to end up in the bathroom downstairs at a gloomy time of the night, on your knees, with a toothbrush and soap cleaning the tiles on the floors.

This was life for us.  The constant not knowing, the deliberate confusion applied to us, surrounding our daily life.  No wonder it was so hard to learn in school, or anywhere else for that matter.  These events shaped our character, built our reactions to life and formed our mistrust of everyone we came into contact with.  It was very hard to let anyone in and when we did it usually came around to hurt us yet again.

How we got through these things and more is still a mystery to me.  I found solace in alcohol, in being the life of the party and also in working more than anyone else.  None of these things helped me or my family one bit.  I have survivor friends who have emotional and mental issues, denying themselves any capacity to be loved, loveable or able to love, seeing themselves every day in a mirror which provides nothing but a feint copy of who they should be, and what these animals took from us, it’s a miracle we survived at all.  And my dear reader, there are thousands who didn’t.  Today the perpetrators are finally being called to account.  Usually kicking and screaming into court, as was my case, the now guilty party denying any wrong doing, like child sex abuse is normal?  It is not normal, it is inhumane, it is self seeking and self serving to the lowest possible form of debased life and it represents a truly sick and troubled mind in which these diseased animals exert amazing power over small innocent children and in the sickness of their depraved minds they think it’s OK.

Russell Robert Walker looked like he did not belong in court, and looked almost bewildered that he was being taken to account for abusing, grooming and treating innocent children like sex toy’s.  Amazingly his victims numbered into double digits in a short career in the Salvation Army.  How poisoned must one’s mind be to want to have sex with a child?

We survive because of hope, I suspect.  Hope that someone will listen, hope that someone will believe, hope that the shame of what was done to us will be somehow washed off as a result of a perpetrator being found guilty, therefore telling the world that we were not a willing participant in this sickness and illness.  We are victims, survivors and damaged children and we are hoping to have the remaining years as pleasant as possible.  For me I think that life always seems unrequited when I look at people I know and associate with and how their lives seem “perfect”.  Yet we as survivors wander around life without the foundational skills to even comprehend how to be like our peers.  Hope, I suspect keeps most of us going, hope that we can yell loud enough at the four winds that we did not do these things willingly.  That an evil sickness perpetrated its way into our foundations and killed a full and rich life for all of us.