Creating cultures of trauma-informed care

In conversation

On the 6th of October The Soke hosted an event that explored the topic of creating cultures of trauma informed care. The evening was attended by those working with children and families in a culturally diverse setting, such as pastoral care teams in schools.

Dr. Shadi Shahnavaz, Author, Systemic Therapist and Head of The Soke's Children & Family Team, was interviewed by Dr Niraj Arora, Consultant Psychiatrist.

The Soke’s multi-disciplinary Family Department of psychologists and psychotherapists were available after the talk to answer any queries and more questions from the audience.

If you would like to attend future events, please email us.

The bigger picture

By way of introduction Dr. Niraj congratulated Dr Shadi on the publication of her book ‘Working Systemically with Refugee Couples and Families: Exploring Trauma, Resilience and Culture’. The book is the culmination of a series of interviews conducted by Dr Shadi, illustrating the complex trauma experienced by refugee families.

Dr Niraj made the point that an individual person should not be viewed as a diagnosis in isolation. The individual is part of a system, a family and a larger environment. With 1 in 5 people suffering from PTSD, the clinical view is firmly on the groups surrounding the individual, confirming that clinicians treat society.

Observations

The awareness, almost too late, that the tumultuous escape and journey to a safe country is in not the end of the nightmare. In fact, for many the trauma continues post-flight as challenges such as housing and employment reinforce the daily notion that their lives are uncertain. Being in limbo exacerbates anxiety and depression over time.

The lack of cultural congruence is another, often overlooked, factor that impacts the mental health of refugees in a new country. When it comes to the preservation of identity, it is often harder to do so with a detachment to meaningful places. Where the loss of politics, class, history and culture is emotional, the physical loss of material objects can be just as devastating. Opening conversations with questions such as “What is the one item you left behind that you miss the most”, can be useful and will often cut through the non-verbal barriers.

Once they receive leave to remain, conflicting emotions inevitably make it difficult to understand why they feel a certain way. Instead of feeling grateful, there’s the shame for leaving in the first place, mixed in with the regret and self-blame for not being able to return.

Reliving of the trauma experience can either lead to avoidance or a state of hyper-arousal.

Male adults may often experience a perceived a lack of status in society, compared to their earlier lives. Female adults, by default, may be more resilient in the face of post-trauma. In instances where the male adult can no longer provide as the breadwinner, it presents a complicated situation that often triggers anger and resentment.

Communication (or rather lack of) will see silence play a key role, similarly non-communication, as a way of protection, and to maintain integrity when there is little connection between a couple.

Children as a result of their integration with the language of the adopted country may become carers of their parents, helping them navigate paperwork and other necessary activities.

Conclusion

These considerations require a cultural awareness to imbue trust from a therapist. Inherent to this is of course the ability to speak the same language, being comfortable without causing offense. If using a translator or interpreter, be aware of the discrete nuances.

The work will be complex, stressful and overwhelming. Take care of yourself.

Cultural nuances should be observed, however if may help to slightly bend a rule in order to garner trust, if required.

Signifying the importance of time, it may be helpful to bear in mind a phrase coined as ‘watchful waiting’. Incidents such as Grenfell come to mind, illustrating the need to keep telling their story.

To learn more about creating cultures of trauma-informed care in an educational setting or corporate environment, please contact Ed Lowther, The Soke’s Head of Partnerships.