Job description: Clinical Psychologist at NHS GG&C; Trauma Service: Trauma & Homelessness Team
Areas of interest: Mental health and wellbeing, Childhood trauma – including being in care or childhood abuse
NHS GGCTS's Recent Activity
"NHS Greater Glasgow and Clyde Trauma Service: Trauma and Homelessness Team
NHS Greater Glasgow and Clyde Trauma Service includes several teams working with complex trauma. The Trauma and Homelessness Team is one of these. It is a mental health team in Glasgow that works with people presenting with difficulties related to complex trauma, who are homeless or at risk of homelessness and who are over the age of 16 years. Herman defined 'complex trauma' as long term, interpersonal abuse, occurring on multiple occasions and often beginning early in life (Herman, 1992). Research highlights that individuals who have experienced repeated trauma, especially of an interpersonal nature in childhood, not only experience post-traumatic stress disorder (PTSD) but also a range of more complex difficulties. These include difficulties with view of self as well as interpersonal and emotional regulation problems. The team offers assessment, formulation and treatment, which includes a range of individual and group psychological therapies that are shown to be effective in treating complex trauma. The team also provide consultation, support and training to statutory and voluntary services, such as homelessness, addiction, and Leaving Care services.
Homelessness and Complex Trauma
Homelessness is often preceded by trauma including childhood sexual, physical and emotional abuse, witnessing or experiencing domestic violence, experiencing violent assaults and rape. Koegel et al (1995) found that women who had experienced childhood sexual abuse were at greater risk of adult homelessness. Research published by Glasgow Homeless Network (2002), indicated that service providers estimated that between 50 -100% of individuals experiencing homelessness in Glasgow had a history of trauma. The relationship however, between homelessness and trauma is bi-directional that is, as well as preceding homelessness; trauma is also a frequent consequence of being homeless (e.g. sexual assault, prostitution, witnessing violence).
Experiencing complex trauma can impact on many areas of someone's functioning. Our clients have said:
- “I feel angry all the time, I don't trust anyone, bad luck follows me wherever I go.”
- “I try and pretend that I am normal and the same as everyone else but I feel different and no-one understands the fear, the guilt, the shame. I can't cope with the memories. This is why I drink.”
Three Phased Trauma Model
The team uses a phased model (Herman, 1992) to address difficulties relating to complex trauma. All phases are underpinned by the establishment of a therapeutic relationship:
Phase 1: Safety and Stabilisation – this phase focuses on improving the safety of individuals with regard to health, emotions, relationships, substances and environment.
Phase 2: Processing of traumatic memories – this focuses more directly on the traumatic experiences. This allows the individual to make sense of and give meanng to the trauma and to reduce distress related to these memories.
Phase 3: Reconnection – the final stage is putting into practice the learning from the first two phases and making links within the community for support in the longer term.
Interventions for Women
Meeting with a trauma specialist may help reduce the distress individuals experience by supporting them to develop better ways of coping. It also provides a safe opportunity to make sense of what has happened to them and to understand how the past is impacting on them currently.
The team works with both women and men but offers specific group interventions to address the needs of female clients. One such group is a creative group which is a pre-phase 1 intervention for women who find it difficult to engage with services. The group uses art activity to improve self-esteem, to increase confidence in relationships as well as developing art making skills.
Another intervention is the Safe and Sound Programme. Many adults who have experienced complex trauma also report high levels of re-victimisation (Classen, Palesh & Aggarwal, 2005). We offer an intervention for women to reduce psychological distress associated with complex trauma and the risk of re-victimisation. This is a ten-week group intervention accompanied by nine individual sessions, which focuses on developing helpful coping and relationship skills in order to improve all areas of safety. The Safe and Sound group is currently being evaluated.
We are currently in the process of developing further interventions for complex trauma, as well as evaluating existing complex trauma interventions and research contributing to our understanding of complex trauma.
For further information about the Trauma and Homelessness Team visit our website: http://www.nhsggc.org.uk/content/default.asp?page=home_traumahomelessness"
Reply To: Childhood trauma and women’s homelessness