Transforming Trauma Episode 033:The Need for Trauma-Informed Care: a Conversation with Dr. Christina Bethell and Dr. Laurence Heller
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In this episode of Transforming Trauma, host Sarah Buino facilitates an important discussion between NARM creator Dr. Laurence Heller and Dr. Christina Bethell, researcher, author, policy advocate, and professor at Johns Hopkins University and the Bloomberg School of Public Health. Dr. Bethell is on the Board of Directors for the Campaign for Trauma-Informed Policy and Practice (CTIPP) and is part of a team of trauma-informed advocates who developed the brief: A Trauma-Informed Agenda for the First 100 Days of the Biden-Harris Administration. Dr. Bethell is leading an effort to promote an agenda of healing and prevention through safe, stable, nurturing relationships, in policy and practice. She is currently involved in multiple research projects focusing on trauma healing, including an article with Dr. Heller, and how to scale trauma-informed trainings for health care professionals on a national level.
Dr. Bethell has had the opportunity to testify before U.S. Congress advocating for trauma-informed care, and is working with members of the American Academy of Pediatrics to evolve the national conversation from our current understanding of Adverse Childhood Experiences (ACEs) and toxic stress, to a greater focus on promoting relational health. Dr. Bethell’s work has centered on creating the research base to “promote family resilience and parent-child connection, and looking at social determinants [for health] like alcoholism and mental health problems, emotional neglect, or emotional abuse.”
Dr. Heller and Dr. Bethell reflect with Sarah their shared focus on spreading effective trauma-informed training to helping professionals who work with clients and communities impacted by trauma. Both Drs. Bethell and Heller share their view of the importance of centering relational and somatic attunement when treating childhood trauma, creating a process that can be replicated, without being manualized. As Dr. Bethell describes, it’s necessary to identify the “common elements and principles of practice, and core competencies,” while honoring that relationships can never be taught in a protocol. This poses a challenge for NARM and other similar modalities that highlight and honor the full human experience, and promote a deeper understanding of nuanced and caring relationships. The pressure to achieve Evidence-Based status often leads therapeutic approaches to follow strict protocols that can lead clients – particularly those that have experienced complex trauma – feeling labeled, reduced, misattuned and even objectified. Dr. Heller shares his concerns about manualized therapies and also his mission of promoting NARM as a humane treatment to those that have experienced complex trauma.
Dr. Bethell suggests that, in fact, there is a need to “flip the script” on how we understand what is the most effective parts of Evidenced Based practices, and begin looking at the common principles and elements that create healthy relationships to support healing. She brings in the exciting movement toward centering medical care on therapeutic presence, and research that is demonstrating that compassion is actually at the center of all other interventions. As she says, “it's kind of like rewiring Maslow's hierarchy and putting the connection at the center.” A theme throughout the conversation is the need to center ‘human-ness’ in the helping professionals’ presence, between the provider and the patient, as well as how the provider relates to themselves.
Drs. Heller and Bethell agree that there is a strong need for more trauma-education and normalization generally, so that as a society we recognize that childhood trauma happens to everyone (albeit in different degrees of severity), and that addressing one’s unresolved trauma is a necessary part of working as a helping professional. As Dr. Heller states, “the people who are doing this kind of work and research are not acknowledging their own fears of connection, their own fears of vulnerability, their own issues with even having compassion for their own suffering.” To do this, providers, researchers, and policy advocates who are leading the trauma-informed movement need to be willing to be in touch with their own vulnerability, and willing to address their own unresolved trauma, rather than treat the topic of complex trauma as if it can be studied and implemented from a totally objective perspective.
They close their conversation discussing the recent shifts within healthcare to assessing, treating and understanding trauma and resilience. They reflect on what is leading to these shifts, including more nuanced research in child and human development, advances in brain science, and re-focusing funding streams to address ‘diseases of despair’, such as addiction and behavioral health. This focus on trauma-informed care has led to the need for effective trauma trainings for helping professionals all over the world. Many helping professionals recognize the basis of health and resilience as being about connection and relationship, but they do not yet have the advanced clinical skills to implement the kind of changes to their practice that are needed.
Drs. Bethell and Heller both agree the NARM Training Institute is at the forefront of what this trauma-informed training could look like for helping professionals from various fields. Dr. Bethell ends the episode with encouragement and a ‘call to arms’ for all NARM-trained, and other trauma-informed professionals, to step into places of leadership and bring their perspective and skills to healthcare, mental health, education and other social systems. As she describes, “[These systems are] aching for support and help on how to ground the concepts of healing, recognizing… developmental trauma, and doing something about it.”
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Christina Bethell is a Professor at Johns Hopkins University in the Bloomberg School of Public Health, where she advances an integrated science of thriving focused on the recognition and healing of developmental and collective trauma. She has sparked and shaped the conversation to make safe, stable, nurturing relationships a matter of public health and policy. She is an avid student of human potential for flourishing amid adversity and is dedicated to the implementation of the national Prioritizing Possibilities agenda to address childhood trauma and promote the relational roots of well-being in policy and practice. She writes poetry, dances and believes that attuned connection with our selves, life and others is the source of our creativity and joy.