Symptoms as Adaptations
A trauma-informed care perspective asserts that all the behaviors we call symptoms or problems are solutions for the client. The client is escaping intolerable feelings by doing a behavior that helps in the moment, even though it has long-term negative consequences.
What are some things we as individuals do that help in the moment and have long term negative consequences? — for example, smoking, over eating, shopping. These behaviors really do help us in the moment, otherwise they would be easy to give up. Like clients, we engage in behaviors that help in the moment despite them having negative long term consequences.
Understanding the meaning and function of the symptoms gives treaters many more options for intervention. If a treater knows drinking alcohol is a way to manage debilitating anxiety, then she can work on other ways to reduce anxiety such as medication, relaxation skills, reducing caffeine, etc.
Understanding a Person
Here are some basic questions to use as guidelines when trying to respond to problem behaviors in a person:
- What has happened to him?
- What has he learned about other people?
- What biological changes has she experienced?
- What skills has he learned to survive?
- What skills does she need to learn?
To understand a behavior:
- Relate it to experiences in the person’s past
- Look for patterns
- Look for what the problem the person is solving
- Look for what actually happens as a result of the behavior
- Consider fear and confusion
- Consider feeling overwhelmed
- Consider feelings of powerlessness and vulnerability
Exercise to try:
- Choose a current client with a current problem behavior.
- List client’s first name and the behavior you are focusing on.
- List at least 5 hypotheses about the way this behavior might help this client solve a problem.
- How do you wish this client would solve this problem?
- What would this client have to know, believe, and feel in order to solve the problem a better way?
- What are three things you could do to teach this client new skills and give them different experiences with other people?
Nadine Burke Harris Ted Talk on ACES
Tips for Understanding Behaviors
- Make sure you know the history of each person in your care.
- Also know the person’s goal or next steps. Where are you hoping the person can go after your program?
- Know the person’s current family situation. Does he or she have family contact? Who is important in his or her life outside of the program?
- Carefully examine when the person’s behaviors happen. What time of day? With whom? In what kind of setting?
- Consider whether the person might be overwhelmed by too much going on at once.
- Consider whether the person feels inadequate or stupid in the situation that proceeded the behavior.
- Look for times when the person feels scared, small and helpless. These are the times when traumatized people often act aggressive and threatening. What could we do to have the person feel stronger and more in control without needing to resort to violence?
- Look for times when the person feels that they have no control, that others are making all the decisions for them. In the person’s life this likely has resulted in people hurting them. So they will fight for control. How can we give them legitimate control?
- Consider the role of shame. Is this person pushing you away so you will not see how “bad” they are? Is the person feeling “I am bad so I might as well act badly?”
- What actually happens when the person does this behavior? Consider whether the behavior helps them escape from something that is intolerable for them.
- Try some interventions based on your guesses about the meaning of the behavior (if you guess that they are scared at night, give them a night light). If the interventions help, you are on the right track.
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