The Traumatic Stress Institute fosters the transformation of organizations and service systems to trauma-informed care (TIC) through the delivery of whole-system consultation, professional training, coaching, and research.

Building the Relationship

The most highly researched aspect of treatment is that change happens when the client feels they have a strong relationship with their treater. This is more important than any technique or other variable. Although we are never able to control the clients, our relationships give us profound influence. Relationships are our most powerful tool to change behavior.. Our clients come to us expecting to be hurt by people, and expecting that people cannot be trusted. If through knowing us they discover that there are good people in the world, people who are trustworthy and who do not hurt them, then we have given them a profound gift. We have made it possible for them to potentially have friends, get married, and get along with a boss. Clinical treatment technique do not work without a therapeutic alliance. So, a high priority every day is to employ strategies and techniques to build, sustain, and deepen positive relationships with clients.  Positive does not mean you give in to them or do not have expectations. Positive means you are honest, empathetic, firm, attentive , and attuned. Positive means you are RICH- offer Respect, Information, Connection and Hope.

A strict focus on accountability, rules and consequences replicates the “power over” dynamics of trauma. Survivors tend to react to these measures by fighting for control to avoid being hurt. We need both structure and flexibility within that structure.

This is how clients learn to trust, how their brains are rewired, and how they learn to regulate their feelings.

Tips for Building, Sustaining, and Deepening Positive Relationships

  1. Get to know the client. What is his favorite color? Has he ever had a pet? What are his likes and dislikes?
  2. Understand the client’s past. Make a time line with her, focusing on everyday things like the color of the house she lived in and something good that happened there.
  3. Be trustworthy. Keep your promises, and if you can’t, apologize and make it right.
  4. Pay attention. Listen to the client, and put away other distractions like phones.
  5. Say you understand how he could feel that way.
  6. Identify common interests.
  7. Mention that you thought of the client on a weekend when you heard her favorite singer or things like that.
  8. Write a journal back and forth together.
  9. Ask the client to play you his favorite songs and tell you what he likes about them.

Creating Change- What To Do

  1. Praise small successes.
  2. Describe differences in the client that you see.
  3. Talk about other clients who have changed.
  4. Validate the difficulty of change.
  5. Discuss the ways that the current behavior helps or meets the client’s needs. How did they learn this behavior in the past? How did it help them survive?
  6. Explore the behavior WITHOUT trying to change it. How does the client feel beforehand? When is it most likely to happen? How does the client feel afterwards?
  7. Even though it seems like a contradiction, we are most likely to change when we feel accepted for who we are now. Show the client your appreciation of them and your caring.
  8. Model your own ways of handling stress, discussing them as you do them. Say things like: “I’m getting a little stressed out. I think I will go for a walk.” Or “I’m taking a deep breath to calm down now.”
  9. Model positive relationships between staff. Let clients observe how you work out differences between each other.
  10. Above all, be a cheerleader. Communicate your faith that the client has a great future ahead of them.

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