Dr. Patricia M. Crittenden – ‘Psychological Trauma & Resilience: A Strengths Perspective’

Dr. Patricia M. Crittenden gives her lecture on ‘Psychological Trauma & Resilience: A Strengths Perspective’. This was recorded, via video conference, earlier in 2020 at the Emanuel Miller Memorial Lecture and National Conference on ‘ACEs, Attachment, and Trauma: new advances in understanding and treatment’.

Accompanying slides.

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Dr. Patricia M. Crittenden studied under Mary. D. Ainsworth from 1978 until 1983, when she received her Ph.D. as a psychologist in the Social Ecology and Development Program at the University of Virginia. In addition to Mary Ainsworth’s guidance and support, her psychology master’s thesis, on the CARE-Index, was developed in consultation with John Bowlby and her family systems research, on patterns of family functioning in maltreating families, was accomplished with guidance from E. Mavis Hetherington. She also holds a Master’s Degree in Special Education, with specializations in mental retardation and emotional disturbance (University of Virginia, 1969.)

Dr. Patricia Crittenden has served on the Faculties of Psychology at the Universities of Virginia and Miami and held visiting professorships at the Universities of Helsinki (Finland) and Bologna (Italy) as well as San Diego State University (USA) and Edith Cowan University (Australia).

In 1992, she received a Senior Post-doctoral Fellowship, with a focus on child sexual abuse and the development of individual differences in human sexuality, at the Family Research Laboratory, University of New Hampshire. In 1993-4 she was awarded the Beverley Professorship at the Clark Institute of Psychiatry (Canada).

In the last two decades, Dr. Patricia Crittenden has worked cross-culturally as a developmental psychopathologist developing the Dynamic-Maturational Model (DMM) of attachment and adaptation, along with a developmentally attuned, life-span set of procedures for assessing self-protective strategies. DMM-based theory and empirical research authored by Dr. Patricia Crittenden have been widely published as books, chapters in books, and empirical articles in developmental and clinical journals.

In 2004, Dr. Patricia Crittenden received a career achievement award for “Outstanding Contributions to the Field of Child and Family Development” from the European Family Therapy Association in Berlin. Currently, Dr. Patricia Crittenden’s work is focused on preventive and culture-sensitive applications of the DMM to mental health treatment, child protection, and criminal rehabilitation.

Transcript

Good afternoon. I’m Patricia Crittenden. I’m very happy to be here at the 2020 Emmanuel Miller National Conference put on by the ACAMH. The talk that I will give is on trauma and resilience. I want to thank Andrea Landini and Udita Iyengar for the help that they’ve given me as I prepared this presentation. Let me begin with an idea that I often hear about mental health treatment, it is a brain science, after all. I think we sell ourselves short.

All psychotherapy is about changing the brain. This is clearest in the treatment of psychological trauma. Psychological trauma differs from physical trauma because it isn’t an injury, a lesion, an infection, something that is physical, that can be seen. Instead, psychological trauma, is a currently maladaptive neural response to danger that happened in the past. That means that we need to talk about danger, neural responses to danger, and why the adaptive quality of danger might change over time.

The frame that I’m going to use is the dynamic maturational model of attachment and adaptation, the DMM. The DMM is drawn from observations of people responding to dangerous events and observing what was adaptive, what was not adaptive, and discovering that the presence, or the lack of an attachment figure made a very substantial difference in how adaptive a person’s response was. ACEs, Adverse Childhood Events are discussed a lot now. But I don’t think they should be confused with psychological trauma.

They’re not the same. Most ACEs are conditions like poverty or family discord. They result in self protective strategies, but not psychological trauma. Some are dangerous events and sometimes they do result in psychological trauma. These events are things like being beaten, by a bully, by your parents, or observing parental violence and being frightened by it. Our discussion today will be about those ACEs that are events and do produce psychological trauma. The first thing to say about danger is that it is normal, it has always been a part of life, and humans are well equipped to deal with it.

After all, we represent an unbroken chain of life, since the very first living cells on earth. Since that time, our genetic progenitors had survived every danger on this planet in three and a half billion years. We are a hardy, accomplished, species, one that is not easily felled by dangerous events, nor even long dangerous periods, such as, wars. But we, sitting here today, in advanced countries, might be misled by our recent history. 75 years since World War II have been the safest period in human history.

We have increased our average lifespan by 30 years in just the last century. Maybe that makes danger seem abnormal, maybe we fear it excessively. But we carry the DNA of those hardy survivors who preceded us. Our brains are evolved to survive danger. The most important functions of the brain are to identify, and respond, protectively, to danger, so as to promote survival, and to identify, and respond, to sexual opportunity, so as to promote reproduction. These are interlocking functions. One must protect themselves, their partner, and their progeny, until the progeny reach reproductive maturity.

Humans are very good at identifying danger and finding opportunities for sex. If we did only that we’d be good at escaping danger and approaching for sex. But our brains are evolved to do much more. The human brain is highly specialised to learn from experiencing danger or sexual opportunity. Learning from experience leads to increased recognition, and discrimination of danger, and better adapted strategies for protection and sexual activity. Learning is a powerful way to increase our range of adaptiveness, and to increase our probability of survival and reproduction.

Both danger, and sexual opportunity, are represented in the brain as activated neural networks that dispose action. Both are represented in multiple ways that I will condense to somatic. Knowing in your bones, having that gut feeling. Cognitive, the implicit recognition of contingencies, and affective tied to the contextual sensory features of the place where we are. Learning modifies networks by changing what activates them in the future, and what actions they dispose. The neural network itself can be a weak association of neurons that are hardly ever activated together again, or a series of primed synaptic associations that activates many neurons at once or repeatedly activates the sequence of neurons, the strengthening, the synaptic connections.

The behaviours disposed by primed networks are more likely to be enacted in the future. Ski tracks can serve as an imaged analogy. An unorganised mind might look like this with no particular pathway being strongly facilitated. An organised mind with alternative pathways might look like this. A traumatised mind with a single over primed pathway might look like this. Two differences stand out in the third trauma pathway. One is the speed of the trauma route and the other is the difficulty of getting out of the route to change course.

Both ideas have implications for treatment of psychological trauma. Let me give a simple example of the power of neural networks to influence future behaviour. I’m a Hunt and peck typist, so I make many mistakes. When I try to retype a correction about half the time I retype the error, even thinking cognitively about the change that I intend to make. Even a single instance of non intense neural connection increases the probability of repeating that pathway. The dangerous past must have a far stronger hold on behaviour, making cognitive overrides very difficult to accomplish, even once, far less in a habitual changed pattern, as we would want as the outcome of psychotherapy.

What happens to a child after a dangerous event, especially what happens with the child’s caregiver, changes the activated network. If the caregiver intervenes, and protects the child, there is unlikely to be psychological trauma. Even if the trauma harms the child, if the caregiver comforts the child, there is unlikely to be psychological trauma. But if the child is neither protected, nor comforted, psychological trauma is a possible outcome. To explain the reasons for this, I need to introduce the [inaudible 00:09:26] concept of zone of proximal development or ZPD for short. A threat that is in a person’s ZPD is a threat about which they are prepared to learn.

Toddlers are not ready to learn about cars, and velocity, they must be protected from streets. School age children are ready to learn about cars, and velocity, and parents, and teachers, spend a lot of time teaching them how to cross streets safely. With adolescents, we no longer discuss how to cross streets. Instead, we stay in their ever changing zone of proximal development and discuss not driving while drinking. When a child is endangered and neither protected, nor comforted, the child’s mind working in it’s ZPD, constructs the best explanation for what happened, and a rule for staying safe in the future.

That explanation, and rule, are often a psychological shortcut that omits from processing those conditions that are too complex for the child to understand or maybe even to notice. As a consequence, one child might overestimate the probability of danger, thus becoming preoccupied with the danger, whereas another child might dismiss the importance of the signals of imminent danger by forgetting the event that no one ever talked about. Displacing the event, for example, onto a sibling, denying the event, altogether, or delusionary changing the event into something safe. In all these cases, the outcome is a rigid, partially accurate, rule for responding to danger.

Such rules run fast, like deep ski tracks, and they’re not easily modified by changing circumstances. Except for preoccupation with danger, all of these responses put the child at risk of not identifying danger in the future. The risk is that as the child continues to develop, the rule will become increasingly mis-attuned to current circumstances on to age based expectations of the child’s competence. Consequently, the child’s response to danger will become increasingly maladaptive. Thus, each instance of exposure to danger, or sexual signals, is an opportunity to learn, to change, and to become better adapted. Protection, and comfort, from an attachment figure, in the child’s ever-changing zone of proximal development are crucial factors that influence adaptation, or psychological trauma, in response to exposure to danger.

Of course, being adapted to the past is not the goal. The brain has evolved to enable us to transform information about the past into the information that we can use to predict the future, because the future is where we will live. The goal is to use memory to prepare for the future. Sometimes the outcome of exposure to danger is not adaptive. Instead, it leaves us stuck in the past or unable to use the past to organise our behaviour in the future.

This is psychological trauma. Why is this important? Mary Heller’s thesis research showed that adult chronic PTSD has roots in dismissed childhood trauma following unprotected, dangerous, events. Although this finding has not been replicated, it suggests a way to identify who might be at greater risk of psychological trauma following an event to which many people were exposed. Heller’s finding is also consistent with the differential outcomes to the school yard shooter in Chatila, California, reported by [inaudible 00:14:13] in 1984.

Danger and sexual opportunity are variable concepts. I describe the developmentally changing danger of crossing streets. Similarly, breasts are a signal for nursing, in infancy, and for sexual behaviour after puberty. I’m going to focus primarily on danger, but sexuality should be retained in your minds. Because reproduction across an endless series of generations is the ultimate test of survival, and because the most severe psychological traumas often include sexuality, especially hidden, and forbidden, sexual behaviour. So back to danger and learning.

Every danger can be described in terms of its relation to a person’s ZPD. To explain this idea to family courts, I constructed a simple danger scale. The lowest level is developmentally normal, expected, dangers from which the child was adequately protected and comforted. At the next level, developmentally normative dangers from which one was protected but not comforted. Or developmentally inappropriate dangers from which one was protected and comforted. At the third level, developmentally inappropriate dangers from which the child was neither protected nor comforted.

At the fourth level, parentally inflicted dangers, without protection, and without comfort. At the fifth level, events that are threatening to adults, as well. And, finally, ongoing severe endangerment such as spousal violence. Notice that when the danger was normal, and in the child’s zone of proximal development, they could handle it and did not need help. Psychological trauma would be unexpected. The event might elicit strong emotions like fear and hate and disgust. But, over time, these would mellow away to sadness, regret, acceptance, or other less action motivating emotions. The primary sources of protection and comfort are attachment figures.

Three ideas can be drawn from this. Attachment figures function to protect and comfort and to facilitate learning. ACEs must be considered in terms of each person’s ZPD and the availability of attachment figures. And attachment, danger and development interact to affect the probability of psychological trauma. Let me give a few examples of psychological trauma from studies I have published. All the cases use the adult attachment interview. The AAI is like a medical imaging procedure. It provides a representation of the psychological functioning of a person, with regard to protective relationships, like learning to read a medical image.

Mastering the skills to identify patterns in AAIs requires specialised training that takes more time and competence than most mental health professionals can afford. On the other hand, skilled classification of an AAI gives not only a snapshot of the mind, but also the developmental history associated with the person’s current psychological status. Four cases can show the potential of the AAI to inform our understanding psychological trauma. Gregor had been diagnosed with chronic PTSD, as an adult, after an accident occurring in the steel yard where he worked.

After seven years he still could not return to work, but he could travel to other countries. The insurance company said he was faking. His AAI showed that when he was a child, he had broken his leg in the same steel yard. And later in childhood, his bloodied father had been brought home on a stretcher from an accident in that steel yard. No-one had discussed these events when Gregor was a child and Gregor had almost forgotten about them. Only the peculiarities of the AAI questions given while Gregor had chronic PTSD elicited information about these dismissed childhood dangers.

What did Gregor need to have learned in childhood that he had not learned? Steel yards are dangerous places. With that information about childhood dangers, Gregor would have been able to decide rationally whether, or not, to accept the risk of continuing to work in a steel yard. After some months of psychodynamic therapy with a warm, empathic, and astutely precise, therapist who had administered the AAI, Gregor married and took on an entirely different job.

The second case is Franny. She had an eating disorder. No one knew why, and repeated hospitalisations only paused the problem. Her parents were caring, but they were frustrated. Franny’s AAI showed signs of psychological trauma, but they were tied to events that could not possibly have elicited psychological trauma or an eating disorder. Franny did not have a history of danger. Her AAI classification only identified an imagined psychological trauma. Franny’s mother provided clarity. She had almost been strangled by her first husband, she had wanted to bury that trauma, to wall it off, so completely, that it could never touch or hurt her precious daughter Franny.

Yet in moments when Franny was especially needing her mother, her mother’s brain sometimes made zip fast associations of the present where they’re dangerous and forbidden to speak about past. And, in that moment, Franny’s mother, sitting right there looking at Franny, was gone. She was psychologically absent from Franny. Franny couldn’t say what had happened. She just felt empty and unseen. Selma Fraiberg spoke about ghosts in the nursery. Sometimes, even in adolescence, unspeakable ghosts break the connection between parent and child.

In her 40s, following many bouts of treatment, and hospitalisation, Franny was still struggling with her weight. She had not married and did not have children.

My third example is Linda. Linda was in court where she might lose access to her children because her behaviour was so dangerously volatile. She could disappear into herself, and neglect her children. And she could unexpectedly lash out violently, especially after the fathers of her children had visited. Linda had been diagnosed with borderline personality disorder. Her AAI revealed numerous psychological traumas that Linda alternately dismissed and brought to life in frightening ways. Her AAI also revealed signs of child sexual abuse by her stepfather, the man who had protected, and comforted, her when her depressed mother was not available.

In her AAI Linda had explicitly denied being sexually abused, to the contrary. She idealised her stepfather in ways that seemed almost delusional. Nevertheless, the evidence of child sexual abuse lay scattered and unconnected, all across her AAI. Images here, sexual, and scatological, language there, sudden tenderness toward her stepfather, in one place, intense disgust, in another. Plus there was opportunity.

Her stepfather had access that could have included sexual activity with Linda. The evidence was like the aftermath of a war time bomb, scattered, torn, debris and a hole, but no visible bomb. This is probable blocked psychological trauma. With her protection, and comfort, tied, inextricably, to unspeakable sexual danger, Linda had no way to correct her childhood mislearning, that danger, and safety, were found together in the best man. That meant she couldn’t learn to choose safe adult sexual partners. And the danger rolled on and on.

Psycho is my last example. Psycho was in prison for multiple murders. He was huge, strong, and jittery, with ticks flying across his face. His interviewer was scared and he said so. That calmed psycho. He felt safer when the other person was more scared than he. As expected, a string of very dangerous events, expressed as complex psychological traumas, were drawn from his AAI. Psycho denied that anything had harmed him, and, sometimes, he even denied the specific events.

Children often deny that which would destroy them if they were to let themselves know. Psycho’s dangers included being deceived by the appearance of safety and then torturously punished by his father for his gullible naiveté again and again. Once his mother had tried to kill his brother. The interviewer asked if it was really him. Psycho denied it, hands across his throat. When the danger had been far beyond his zone of proximal development and the source of danger was his parents, Psycho, with the logic of a school age child, learnt that comfort signalled danger, and others’ fear kept him safe.

When asked if he wanted to choose a pseudonym for his AAI, he chose Psycho. Did keeping us off balance, and afraid of him, comfort him? In adulthood, Psycho retained information about the past danger, but only in implicit, indirect and preconscious ways that made him fear safety. Psycho remains in prison where he belongs. I don’t think we know enough, now, how to resolve such severe psychological trauma so that we cannot feel confident that Psycho could be even minimally safe outside of prison.

In all four cases, dangerous events had occurred in childhood. They were outside the child’s zone of proximal development. No-one had protected, and comforted, the children at the time, nor discussed the events, when misunderstandings could have been corrected. And, finally, they were in a dismissed form. Opportunities for accurate and predictive learning about staying safe were lost, both at the time of the dangerous event and in the years that followed. Instead, the neurally immature brains of the children did the best they could, with the information they had, using their incomplete capacity to process information, to predict future danger, and to organise protective responses.

Nevertheless, the neural networks were there. They had few associations and their meanings were often transformed. I felt fine, it didn’t hurt. The childhood neural pathways were reified without correction and alternative pathways were not developed. Learning can occur, anytime, but only if you can say what happened and gain an accurate perspective on it. It helps if someone listens, it helps even more if they are comforting and support your learning now, that which was passed over, in the past. It helps if they have expertise in the various ways in which the mind can represent information about danger, from pre conscious, to implicit, to verbalised, and explicit, for somatic, cognitive and affective information.

This slide is packed. I don’t expect most of you to follow all of it. But it does show the different kinds of representations that exist, and the degree of consciousness about them. It also helps if this person can read between the lines, not only the content of the speech, but also hearing the way the ideas are set. It seems worth noting that to tell these four stories I used images, analogy, metaphor, rhyme, connotative language. These are among the linguistic structures that are coded in AAIs to yield evidence of psychological traumas. When past danger is dismissed or blocked from conscious recall, others cannot know about it directly, and therefore other people can be of little help.

This is why I think psychological trauma in a preoccupied form is less serious than dismissed or blocked psychological trauma. In some models of trauma, resilience is thought to be a protective trait, a part of the person themselves. This idea comes from material science in which resilience is the ability of a substance, or an object, to spring back into shape. Put another way, by this definition, resilient individuals return to their pre danger state after exposure to danger.

The DMM takes a different approach, one that begins by identifying the life sciences as reflecting systemic processes. Life is development. It starts, it progresses, in nonlinear ways, and it rarely returns to previous states, particularly with regard to danger. Life learns and learning changes us. The learning can be changed behaviour, new antibodies that modify immune responses or changed neural networks. Put another way, what doesn’t kill you makes you stronger. The point is that when you change, you increase the probability of future survival.

In DMM terms, exposure to danger provides information with which to refine one’s self protective strategy. Each time one adds to the array of signals, and responses, one elaborates, specifies, and conditionalises their self protective strategy. Thereby one becomes resilient to a wider array of threats, and also becomes increasingly confident that one will figure out how to respond to future unknown threats. Resilience is most easily achieved when a child is supported to act, when they can protect themselves. Is assisted to learn to protect and comfort themselves, in the zone of proximal development, and is protected, and comforted, when the danger is beyond their capacity for self protection.

Parents who over protect their children and comfort them excessively teach children that the parent thinks they are neither competent nor resilient. Even if the child feels competent, they still might defer to their parent’s judgement, thus accepting the belief that they are fragile. Well meaning traumatised parents sometimes over protect their children. This doesn’t usually lead to psychological trauma in their children, although it can lead to imagined forms of psychological trauma like Franny who had the eating disorder. But overprotection does undermine resilience.

Parents who fail to protect and comfort their children, when such care is needed, for their children to make the best meaning they can of the event. This involves psychological shortcuts and may include psychological trauma. Either way, the child develops a rule about the signals of danger and responses to danger. The rule omits important information and may include irrelevant information. In the future, this rule, expressed as a facilitated neural response that disposes behaviour, can cause the child to act in immature, and irrational, ways that are inadequately differentiating one danger from another and that might cause harm.

Such unprotected children are not learning to be resilient. Instead, they are rigid in adherence to previous neural and behavioural routines. That is more like resilience in inanimate objects. In DMM thinking, symptoms of trauma signal the urgent need to complete the learning that was stopped in its tracks long ago. But what is the traumatised person ready to learn now? What is their current level of maturation? Answering this crucial clinical question requires precise developmental knowledge about the person and about their family members.

In other words, to be a good clinician, you need to be a good developmentalist. Change can threaten families. A crucial ingredient in accepting the risk of change is trust in one’s own capacity to solve problems. Clinicians often focus on deficits, but pointing to past survival is a powerful tool as well. In closing, let me give an example of treatment of psychological trauma. Again, I’ll tell a story this time of Dana. Dana was included in a pilot programme for multi problem families who had exhausted the services that were available in Barrow in Furness.

The programme was called Love Barrow Families. It was run by two Masters level clinical social workers. Katrina Robson was the therapist and Alison Touby was the home worker. They had a close bond to each other and they functioned like a parental dyad. When a family entered Love Barrow Families, each member was given the appropriate DMM assessment of attachment by Trina, who was trained, and authorised, to give the assessments. The assessments were sent out for classification by trained and reliable coders.

I classified Dana’s AAI. Reading ,as if it were a sentence, this very complex classification says that Dana showed persistently lowered arousal and expectation of failure including falling asleep as well as several psychological traumas. She was preoccupied with physical, and emotional, abuse, and neglect, with child sexual abuse, and with having been in foster care. But at different points in the AAI, she also displaced these events onto other people and tried to escape the discussion with changes of topic and somatic sleepiness.

She also expressed a pervasive feeling of loss about which she felt helpless, and depressed, but never stated directly what, or who, was lost. She used a variety of compulsive [inaudible 00:38:25] strategies, never sticking to any one strategy. Her aggressive strategy was absolute and murderous. But it was without any suggestion of strategic action, no plan to attack, no deception to make it happen, no generalisation to other people. It was more a flat statement of her hatred without implied action. When I sent Trina the classification, written out with considerable detail, I gave some ordered suggestions for treatment.

Dana needed to regulate her arousal, first through medication and then through personal activity. Because Dana had explicitly refused any more trauma based treatment, she had had enough, I suggested asking her to look back at her childhood to identify how she had survived. This reframe was intended to give her a sense of agency and also to enable her, with her adult brain, to assign her self protective responses to particular situations and then explore new responses from an adult perspective. She would be elaborating, specifying and conditionalising her strategies.

She would be undoing the psychological trauma and thus becoming more competent, more adaptive, and more resilient. When she did this, Dana discovered that her son, in foster care, probably felt rejected like she had felt when she was in foster care. This created empathy, toward her son, who had made her feel so incompetent that he had had to be removed. Now she felt compassionately connected to him and able to work toward bringing him home. Magic dust. The two social workers who carried out this intervention said that the result was like sprinkling magic dust over troubled lives.

That’s their term for the DMM and its power to change neural networks. My understanding is that they were the magic dust. They provided the protection and comfort in Dana’s adult zone of proximal development that enabled Dana to become resilient. They functioned as transitional attachment figures in Dana’s ZPD. How do I know that Dana became resilient? Dana’s son was returned home. There were no more child protection complaints. Later, Dana asked to join Trina and Alison as a volunteer to work with other families.

She spoke to groups of professionals, telling them her understanding of her change process, success, success, more success, resilience. But, sooner, or later, life brings new dangers. When it did and Dana felt overwhelmed she returned to Love Barrow Families asking Trina and Alison for help. She had learned a new strategy for solving overwhelming problems, and she had used it, at the right time, and with the right people. Was Dana fully resilient? No, she was becoming more resilient.

We are all works in progress. The advantage of resilience is that better strategies cover more dangers and practice with learning new strategies prepares one to learn again in the future. Resilience is earned one success at a time. Now, six years later, Dana is the LBF receptionist who is dedicated to welcoming new troubled families and speaking to professionals about what works. Her son is 15 and he treats Love Barrow Families like a second home. This is so different from what I usually see in families that are taken to court where failure has followed failure has followed failure, and neither the parents, nor the professionals, feel resilient at all.

Carefully planning the interventions in the parent’s zone of proximal development could have led to a series of successes such as we saw with Dana. How much skill is needed to do what Trina and Alison did? Like medical treatment of disease, differently trained people may be needed to screen for cases, to carry out assessment procedures, to interpret the assessments, to designate the order of the treatment and to deliver the treatment.

Mental health has largely assigned all these functions except possibly psychiatric diagnoses to one professional, one therapist, doing so for invisible psychological problems, when concrete physical health receives layers of professional skill might contribute to the relative lack of progress in mental health treatment. Most mental health professionals can learn to deliver DMM assessments, and they receive certificates to attest to this. Very few, however, become reliable at classifying DMM assessments. That requires a different set of skills, just as reading medical scans does.

Designating and ordering the treatment needs of the traumatised person requires fine tuned developmental knowledge. Most clinicians lack that. Finally, having a good theory of treatment helps. We are working to ensure the DMM integrative treatment includes all the strengths of all the theories of treatment. Maybe treatment of psychological trauma requires as many forms of expertise as does physical trauma. Possibly it requires more because the problem is not visible and concrete and because there is much less research on the treatment components that underlie psychological trauma.

Without doubt, these ideas, if implemented, would lead to more research and a massive change in how we train, and deploy, mental health professionals. The question, of course, is whether, or not, a new focus and research, and means of service delivery, will improve treatment success for the millions of people who suffer from psychological trauma. Of course, you will ask about cost. Dana’s treatment, including the DMM assessments, cost peanuts compared to foster care for her son. In reduced suffering, the value of the treatment is beyond imagination for five people.

Plus, another 20, or so, Love Barrow Families that received the same advantage. How much our safe and happy families were now and into the next generation? Let me offer a few takeaway points. Learning to identify, and respond, to danger is central to resilience. It can be learned. Complex psychological trauma may have roots in dismissed childhood trauma. Complex cases need valid relationship assessments of patients, sometimes their parents, and sometimes their children. If they have dismissed the traumas, they cannot self report them.

Therapists shouldn’t do everything. A sequence of skilled professionals is needed, just as it is in physical medical care. Interpretation, or classification, of the assessment requires specialised skills. The amazing thing about these assessments is once they’ve been videotaped, or transcribed, they can be sent anywhere. The skilled person doesn’t have to live in your community, they can live across an ocean. Seventh, employing developmental psychologist could help to improve treatment planning, because they can think about learning in each person’s zone of proximal development.

Treatment delivery is enhanced when the professional functions as a transitional attachment figure to the person in treatment. Good and early assessment saves money and suffering. I almost never get to carry out these assessments until courts are planning to take the children away. But had they done this as soon as multiple problems were apparent, we could have built in success, and resilience, and had the family at much reduced cost, out of the system, and functioning at least minimally adequately.

And, finally, resilience is learned one success at a time. How much of this is true? Well, I’m a clinically informed developmental psychopathologist. There are details of fact in what I have said, and these are true. But the truth of treating psychological trauma lies in each patient therapist relationship. What I offer today is a reworking of what we already know, an updated integration that could be used to improve treatment to the many families suffering from the effects of psychological trauma.

I hope we can imagine a future with differently highly skilled professionals working together to build resilience amongst the troubled families we see.