Monday, March 6, 2017

Conference report, part five: NYSDRA and childhood trauma

This is the fifth in a series of blog posts about two conferences I attended this fall (NCDD and NYSDRA).
  1. started by describing the Red-Blue Dictionary and the exercise I designed for it (which I call "Ground Truthing with Stories").
  2. Then I described a new conferences-and-meetings variant of the "Twice told stories" exercise, called "Bubble up stories," I designed for a NCDD plenary session.
  3. Then I described a "Sticker stories" landscape exercise I designed for a session on story work.
  4. Then I talked about Cross method mapping with the Group Works cards.
Now I'll finish the series with an account of some other meetings and conferences I attended and talk about what's coming next. (Actually, this post was supposed to complete the series, but it turns out I will need one or two more posts to do that. You'll see why later.)

Dispute resolution

NYSDRA is the New York State Dispute Resolution Association. It's a professional association of mediators and other professionals and volunteers who help people resolve contentious disputes. They support a network of Community Dispute Resolution Centers (CDRCs) across the state. 

It's not hard to find connections between story work and mediation. Here's a description of what mediation is about from the NYSDRA web site:
Mediation is a method for discussing problems and exploring solutions with the help of a trained neutral. Mediators help people communicate clearly and negotiate effectively. Mediators do not take sides, give legal advice, make decisions about resolutions or impose solutions. Mediation is private and voluntary. Research shows that mediation frequently results in agreements that are voluntarily followed because they are created by the people directly involved.
Like PNI, mediation depends on participation, collective inquiry, and sensemaking. Our goals and means are similar.

An aside on goals and means

By the way, I've been thinking about how fields of practice tend to be defined either by what they want to accomplish or by what they use to accomplish things. You could call this a goals-first or means-first orientation. It seems like a useful distinction.

PNI is unabashedly means-first. It walks around with stories in its hands seeing what it can do with them. This orientation has several consequences. For example, PNI isn't participatory because of anything anybody wanted; it's participatory because stories are participatory. Sure, you can get useful outcomes from non-participatory story work, but you can't get to the really useful outcomes until you invite people into the project. The tool tells us what we can do with it.

I've noticed that when a means-first approach meets a goals-first approach, the two approaches usually get along fine. The goals-first approach is eager to hear how the means-first approach can help it meet its goals, and the means-first approach is eager to find new goals for its solution to work towards.

When two goals-first approaches meet up, they tend to greet each other cordially but have little to discuss, because they work in different domains. But when two means-first approaches meet, things get complicated. It takes self-discipline and humility for two means-first approaches to find ways they can work together, because each is defined by the utility of its solution.

Let's say we are both carpenters. Say I work on house framing and you build little intricate cabinets. We aren't likely to compete or disagree on how best to do carpentry, because we both know that what works for a house doesn't work for a cabinet. Now let's say I take a break from house framing and notice an interesting tool you are using. In that situation we can have a nice little discussion, and maybe I'll learn something. But now let's say we both do general carpentry, and you use every brute-force power tool known to man, while I insist that only hand tools can provide the intricate control needed for quality work. In that case we might have to work out a compromise before we can work together.

As I have talked to proponents of this or that approach over the years, I've learned to pick up pretty quickly on whether the person I'm talking to, or the approach they use, is concerned more with means or goals. I've learned to adapt my conversation (and my self-discipline and humility) to whatever the situation requires.

Why am I telling you this? Because I've been thinking about how people who use different approaches could communicate more effectively with each other. This little exercise of talking about whether each of two approaches is means-first or goals-first, then talking about how that affects possible relationships, could be a useful adjunct to the cross method mapping process I talked about in my last post.

Stories and childhood trauma

But I was supposed to be telling you what happened at the NYSDRA conference. Well, to start, I facilitated a repetition of the "Bubble up stories" exercise I developed for the NCDD conference. It went very well. Everyone seemed to enjoy the exercise and learn from it, and I learned more about its dynamics (which improved my exercise instructions).

Then I went to several conference sessions, and listened, and thought, and took notes. Two of the sessions stuck with me most. The first was about childhood trauma.

I'm sure some of you know about childhood trauma, but I'll summarize a little of what I learned for those who don't. Childhood trauma is generally caused by events that take place up to around age nine -- because after that age, children are more able to understand and process events as they happen. Trauma can be caused by acute crises (like accidents or deaths) or chronic conditions (like illness or abuse). Whether events are traumatic or just difficult is influenced by the presence or lack of compensating factors such as emotional support. A child's own temperament also plays into their perception of events, so one child might be traumatized by events that another shrugs off as just the way things are.

In adulthood, childhood traumas sometimes continue to affect people by making them vulnerable to triggers that remind them of the events of the past. When people encounter such triggers, they can experience flashbacks, sometimes vague or even unconscious but still powerful. People tend to respond by "acting in" (withdrawing or hurting themselves) or "acting out" (losing empathy or hurting others), sometimes without realizing that they are responding to events that happened decades ago.

The conference session I attended was about how mediators could learn to avoid triggering their clients' memories of childhood traumas, recognize the symptoms of flashbacks, and help people cope with the feelings that arise as a result. For example, the presenters mentioned how police and court surroundings can trigger flashbacks in people whose traumas had to do with force, intimidation, or abandonment, and they explained how mediators can ameliorate those effects by providing emotional safety, listening, keeping people informed, using transparent processes, empowering people to make their own choices, and so on. They also cautioned mediators to look into their own pasts to discover whether they themselves were hampered in their mediation by memories of past events.

In the field of story work, narrative therapy has been addressing the issue of trauma at the individual and family level for decades. Its approach of helping people focus on hopeful solutions and pay attention to neglected positive stories of support and resilience has helped countless people.

It seems to me that participatory narrative inquiry can complement this work at the level of communities and organizations. PNI could, for example, help with the training of doctors and nurses and teachers and social workers; the design of offices and waiting rooms and police stations and youth centers; outreach campaigns; crisis detection and action networks; and so on. Because of its collective and participatory nature, PNI is uniquely suited to provide systemic solutions to the widespread detection and mitigation of childhood trauma and its aftereffects.

I began my exploration of this topic by telling myself some stories about projects I think could help with the issue. To map possibilities, I made use of my story-functions triangle, which is my way of saying that people share stories for three reasons:
  1. to inform and instruct
  2. to connect and engage
  3. to inspire and persuade
Use these three dimensions, I've come up with six future-history stories (two per triangle vertex) about potential PNI projects that could address childhood trauma in some way. Please note that I am seriously uninformed on this topic! But I'm plunging in anyway, in the hopes of generating discussion and finding future collaborators.

Stories to inform and instruct

Early detection. Our medical practice regularly collects stories from patients and their parents as they visit our offices. We screen these stories for signs of trauma such as beliefs among children of being "not good enough" or being to blame for illnesses. When we find such signs, we connect parents with helpers who can answer questions and provide support. 

And we send the children to the theatre. Our new story theatre, complete with an array of posable puppets and costumes, allows children to play-act their feelings about what is happening to them. This helps our counselors explore the features of emotional trauma even in very young children. Taping theatre-play sessions without the parents present, then showing the recordings to the parents (with interspersed discussion by counselors) helps parents understand the signs their children are giving them and learn to respond accordingly. In addition, the body of video recordings we have collected (anonymously and with permission) gives us an excellent training base that helps caregivers and parents understand the signs of emotional trauma so they can be ready to respond to them as they happen.

Trauma-informed design. Our hospital has been collecting first-hand stories from children and adults in our care over the past two years. When we first started collecting stories, we had an idea that we might be able to use them to think about trauma. So we made sure to tag each story with information about where it took place, when, with whom, and under what conditions. Then we had three child psychologists go over each story (as told by a child or their parents), annotating it with connections to signs of trauma (based on prior research).

From this we were able to discover that two of our departments were disproportionately prominent in trauma-sign cases. Further examination led us to changes in those departments. For example, we discovered that the informational signs in our testing department, though efficient in guiding parents to the right locations, were described by children as looming menacingly over them. The signs featured prominently in the nightmares of several young patients. We worked with a visual designer to better balance our needs for efficient direction with colors, fonts, and other design features that reduced the alarming nature of the signs. In follow-up monitoring, our testing department signs seem to have lost most of their alarming nature for children.

Another change has been in the nature of how we train nurses to speak to children about the nature of their illnesses or injuries. In the past we spoke to children of each age in a uniform way. But based on the stories we collected, we were surprised to find -- though it seems obvious in retrospect -- that the same explanation might reassure one child while causing trauma in another. We discovered that children respond to explanations predominantly along dimensions of trust ("I believe everything I hear from those in authority" to "I question everything I hear") and curiosity ("I'm fine with a simple explanation" to "I want all the facts"). We also found that children can transition between one of these states to another during the course of their hospital stay. As a result, we devised a simple diagnostic tool (combining observations and questions) that doctors and nurses can use to help them speak to children about their conditions. For example, some children are still given the old-style simple explanation of their injuries or illnesses, but others are shown detailed test results and are encouraged to ask penetrating questions as to why certain protocols are followed. Since implementing this diagnostic system and protocol, we have seen a significant drop in the number of children who describe their experiences as bewildering and frightening. We count this as a major success, one that we could not have imagined before we saw the hospital experience through the eyes of our young patients.

(Remember: I'm making these stories up. There's no evidence, as far as I know, for any of the things I'm describing here. I am envisioning some of the types of results that could conceivably come about during story work on childhood trauma.)

Stories to connect and engage

Mutual support. Our support network's collection of anonymous, real-life stories about childhood traumas is used by parents, caregivers, and teachers to compare the situations they face with similar situations others have encountered. The stories help them gauge the severity of problems, consider non-obvious dangers and opportunities, discover common patterns, and gather ideas when they feel stuck.

Several factors have come together to make this project a success. The fact that both contribution and use of the collection is completely anonymous helps people tell and learn from stories in an atmosphere of safety and quiet reflection. It is also important that, in our interviews, we have drawn out the positive side of the stories, the ways in which people have drawn strength from adversity. I had the chance to watch several people use the system when we were testing it, and I interviewed them afterwards. As they read story after story, they said, they experienced an increasing sense of community, mutual support, and hope. That was exactly why we built the system. 

Story-mediated mentorship. We've had a mentorship program for parents of children affected by trauma for over a decade, but last year we added some elements to the program that have made it much more effective. We use stories in three ways. 

First, we ask potential mentors -- that is, both parents who have helped their children through trauma and adults who have recovered from childhood trauma -- to describe themselves to potential mentees via stories. Typically we ask them about their biggest challenges, their most fruitful learnings, and their proudest successes. People who are just coming into the system, instead of being assigned a mentor, are given a list of possible mentors and encouraged to read their stories before choosing one. This gives mentees an understanding of the base of experience their mentors will be drawing on; it finds better fits between mentors and mentees; and it gives mentees a sense of agency in making their own choices. 

Secondly, we train our mentors in the art of the narrative interview, so that they begin their work by drawing out the stories that define for mentees the shape of their experiences. This happens both in interviews with the parents and in the story theatre with children. Mentors who need help conducting these interviews can be mentored themselves in narrative methods. In fact, some of our most experienced mentors have become mentors both in trauma mitigation and in story techniques. As a result of this deepening of the initial contact, our mentors and mentees no longer start their relationships with "just the facts" about a child's traumatic experience; they have a more complete picture to work with.

And thirdly, we encourage our mentors and mentees to use story sharing as a way to monitor and celebrate progress in their journey. Taken together, these three improvements to the mentoring process have given us a collective boost to the health of our community.

Stories to inspire and persuade

Parents as heroes. Our case workers are trained to recognize the symptoms of trauma in children; but they sometimes have difficulty convincing parents (primarily parents, but also other caregivers such as grandparents and older siblings) that the children in their care have experienced particular events in a traumatic way. Signs of trauma can be easy to overlook or dismiss. In the past we found that parents sometimes took our attempts to clue them in as attacks on their parenting. We felt that it was important to find a way to communicate the existence of the problem, the availability of help, and the potential for success, in a way that included, respected, and empowered parents and other caregivers.

For these reasons we created two video series, each based on amalgams of real-life stories: "Inside the mind of a child" and "Through the storm." The first series shows what a traumatic experience is like through the eyes of a child, using a series of vignettes: a house fire, domestic violence, a car accident, a sudden illness, school bullying. Parents can watch one or several of the episodes. We use dramatic devices such as foreshortening, oversized furniture, strange angles, and other means of illustrating the powerlessness and confusion children experience while struggling to make sense of frightening events. We also feature some of the most common mistaken beliefs we see in traumatized children -- I'm no good, it's all my fault, I'm being punished, and so on -- and that parents often overlook or dismiss. Our goal is for parents to watch the videos in this series and better understand the importance of listening deeply to their own children in crisis. After parents watch this video, we discuss how they can work with their own children to listen more carefully to what they are going through.

Our second series casts the parent or caregiver in the role of the hero: the person who discovers the problem, listens carefully to the child's perspective (thus modeling the lesson from the first video in the second), and takes concrete steps to support the child, transforming a traumatic experience into an experience of support and strength. As in the first video, the story is repeated in several contexts, and the parent can watch one or more. This video ends with an explanation of the steps the parent in the video took, and an accompanying handout helps parents remember these steps when they get home. We watch this video with parents and encourage them to pause the video when they want to react to or discuss what they are seeing. We end the viewing with a discussion that helps parents map the stories in the video to the situations they face.

This story-based grounding in the realities of childhood trauma has proved so successful in our work with parents that, apparently, word has started to get around. We have been getting requests from parents for a viewing even though their children have not encountered any traumatic events. We have been in contact with the county health clinic, which provides parenting classes to the community, to offer a facilitated viewing experience to people who come to their classes and want to educate themselves in case of any problems in the future.

Healing old wounds. It is part of our mission to reach young adults who are struggling in their lives due to childhood traumas they have not yet fully understood. Many of the clients we work with have issues with substance abuse, depression, and anxiety; and many grew up in difficult circumstances. Our goal is to help people work through any issues that result from childhood trauma without making things worse by giving the impression that they are damaged beyond repair.

We decided that we wanted to offer our clients three interlinked benefits: the opportunity to recognize, without embarrassment or undue attention, the symptoms of childhood trauma in their own lives; practical steps they can take to address newly discovered traumas; and hope that such practical steps could lead to real improvements for them. We started by finding as many adult survivors of childhood trauma as we could, drawn mostly from the graduates of our programs and from related programs across the city. We conducted confidential, anonymous interviews with forty adults, asking them about the nature of their childhood traumas, when and how they realized how those traumas were impacting them as adults, what they had done in response, what sorts of help they had sought and received, and how their lives had changed as a result of addressing the issues. Our interviewees gave us everything we hoped for and more. Their experiences were diverse, compelling, and enlightening.

Our next task was to get the stories we had collected in front of our clients. To begin with, we knew that our clients were at a variety of places with regard to childhood trauma. Some were not yet aware of its impact on them; some were aware but ignoring it; some were actively working on solutions; some had lost hope. We realized that different people would need not only different stories from our collection, but different parts of stories, to meet their needs.

We also knew that control would be an important issue. Our clients are used to being presented with beautiful solutions that might or might not match their real needs or conditions. If our stories came off as staged or too polished, our clients would not take them seriously. We needed to keep the raw, honest authenticity of our stories intact. To do that, we needed to hand over control to our clients in a way that felt natural, familiar, and safe.

So we set up a simple text message autoresponder. It's simple, direct, and private, and it places control squarely in the hands of our clients. We give clients a number and a code. They text the code to the number, and add an extra number and letter, like 1A, to the code. The autoresponder texts back one part of a story from our collection, exactly as our interviewee said it (minus any identifying details). Each story has four parts: the childhood trauma itself (A), later impacts (B), their response (C), and the story's resolution (D). There's also an (E) code with links to sources of help mentioned in the story.

This sounds like an arcane system, and it is -- for a reason. We've found that our clients like playing a sort of game with the story collection, choosing when and where to read different parts of stories. Because the stories come in pieces, people can focus on whatever parts they are most interested in learning about. The autoresponder log gives us an idea of how people use the system. For example, we've seen people run down the A and D elements of the series, possibly looking for traumas they recognize or outcomes they'd like to achieve. We've also noticed that certain parts of certain stories have become a sort of shared language for trauma and its aftereffects. We sometimes overhear clients saying something like "you need 28B" or "get yourself to 17C."

It's hard to put numbers on the success of a program like this, but there are some early signs. Our forty collected stories have been read hundreds of times. But more importantly, in the past month five clients have come in wanting to talk about particular stories. That's an oblique way of asking for help, and it's one we could not have achieved without the power of the real stories people helped us collect. Right now we are preparing to add another twenty interviews to the collection. Overall, I could not be more proud of our team and of all our contributors.

* * *

So those are some pipe dreams about projects that could help people who are understanding and recovering from childhood traumas. If you are interested in this topic and want to collaborate, or just discuss ideas, let me know (cfkurtz at cfkurtz dot com).

Next: Stories and NVC

The second session that stuck in my mind during the NYSDRA conference was on Non-Violent Communication. My reflections on that session have sparked another exploration into potential synergies -- but I've written enough on it that I decided to end this post here and continue in my next post (coming soon).

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