CHANGING THE QUALITY OF TRAUMA IN CHILDREN AND FAMILIES. David Trickey is a Consultant Clinical Psychologist who has specialised in working with traumatised children, young people, and their families since 2000. He is Co-Director of the UK Trauma Council, chartered by the British Psychological Society and registered with the Health and Care Professions Council. Across all of his roles, he draws heavily on the published research literature, to which he has made his own contribution.
27 minutes read time.
You can listen to the podcast of this interview here.
David Trickey, why does a child become traumatised?
Traumatised children are not all the same, and that’s really important. Some reactions are more common, but two children can experience exactly the same event and yet have very different reactions to it. So trauma isn’t just about the experience and the events that happen, it’s how those events are stored in people’s memories. It’s what those events come to mean, and whether the world around us supports us to recover. It’s less about the event and it’s more about the person’s meaning making and the memories. That’s really what’s going to predict if different events become traumatic or not.
Is family the first place where trauma starts?
Some traumatic events happen within the family, and that can sometimes be more traumatic because people learn to expect their families to be safe. People learn to trust certain people and when that trust is betrayed and they end up being the person that’s harming them, that can be incredibly traumatic. I work with an eight-year-old girl who was abused by both of her parents. She said if it had been one of my parents that might have been about them, but both of the two people who should have cared for me hurt me, so there must be something about me. Those events led her to question her own identity.
“An important part of getting through traumatic events is being able to make sense of them, to think them through, and as social beings we will often do that with others.”
David Trickey, how do people process that profound questioning of identity that comes through experiencing trauma?
The message of the trauma for some people will be that the whole world is unsafe. Other people are violent. For some people the message is, people like me are vulnerable. Or bad stuff is always going to happen to me. Or I’m unable to affect any influence over what happens around me.
How do you start to work on that with people in therapy?
I can start to unpick that with them, particularly adolescents and older children. I can start saying, “Where did you learn that you have no control over what happens? And is that absolutely true?” And they go, “Yes, it’s absolutely true.” “Okay. What would happen if you got up and walked out of this session now?” “Well I can’t do that.” “Give it a go.” And hopefully they’ll either laugh or they’ll get up and walk out, and then I’ll put my head around the door and say, “What happened? You have control.“ That doesn’t magically fix everything but it does begin to do two things: it chips away at this idea I’ve got no control over anything if that’s a problem but also it makes that assumption talkable about; and suddenly we’re having conversations about it.
What are the solutions your work offers?
My work with traumatised children, young people, and families is not to help them forget what’s happened. My work is to help to process and to make sense of what happened. Traumatic memories are very different to normal memories. They are stored as the sharp data of the event:- the sights, the smells, the taste, the touches, the thoughts, the feeling; rather than the narrative, the story. These traumatic memories are very intrusive, and very easily triggered. They drop into children’s minds out of nowhere, and they’re avoided. Of course. Who wants to be remembering those events? My job is to help the young person to feel safe enough to bring those elements of their memory together and to create a more normal memory. The quality of the memory might change through our work. It might still be frightening, but it’s not going to be intrusive or overwhelming. It’s something they can start to take control over.
Can trauma that happened when you were young still affect you aged 80?
Certainly the impact of those events can follow people around, but it’s not inevitable. People can experience the most horrific events and to an extent those events will stay with them, but they won’t necessarily be traumatised by them. There are things that can be done to help them to get through things.
How is trauma detected?
There are some common symptoms, for example, intrusive memories or nightmares or flashbacks. Because these memories are so different, they intrude into consciousness, but people might not be sharing that. They might be embarrassed or ashamed, either about what happened or about the fact they’ve got symptoms. Also, as I said, they don’t want to be thinking about them. If I went into my child’s bedroom in the morning and said, “I heard you shouting in the middle of the night. Are you okay?” He might not want to be remembering the nightmare he had. He might go, “Yeah, no, I’m fine dad.” Because they avoid thinking about it, people avoid engaging with the memories, because it is unpleasant, because it is distressing. They end up not really sharing them with other people, and people spend a lot of time and effort and energy trying to avoid it, because they don’t want to think about it; and that actually becomes part of the problem.
When trauma is detected, is it good to talk about it?
Not if they don’t want to, but it is good to give them the opportunities and the support to be able to. A lot of the young people I work with have these memories that are intruding, these ideas that the world is not safe. They have the idea that it might be their fault in some way, and they’ve got all this stuff going around in their heads. Sometimes what I do in therapy is nothing particularly sophisticated, I just provide the safe space where they can start to get these thoughts out of their heads and start to make sense of these experiences. An important part of getting through traumatic events is being able to make sense of them, to think them through, and as social beings we will often do that with others. So it’s not good to make people talk about it, but it can be really helpful to give them the opportunity, the support and the strength to be able to talk about it.
“It can be incredibly powerful for people to hear an apology even decades later.”
David Trickey, is there a medicine that calms trauma?
We don’t have any good evidence that there’s any medication that helps for children and young people. For adults, there’s an interesting debate about whether certain psychedelics might help people with processing the trauma. I don’t think it fixes the trauma, but it might allow them to think differently about what’s happened in their past. Medication might help, but it probably won’t be the only thing that people need to be able to process the trauma and to put it behind them. If we think about post-traumatic stress disorder (PTSD) as a reaction, perhaps if the trauma leads to a low mood it might be that people are prescribed antidepressants, rather than an intervention that will help them to unpick the events and to make sense of them, to get through them in a different way.
Are some parents completely unaware of their child’s trauma?
There’s some really nice research that shows that if you only ask the parents, you get much lower rates of post-traumatic stress disorder (PTSD). Some parents are not aware, not through any fault of theirs, but children may be hiding some of their difficulties from their parents. I worked with one boy and when the mum and dad were in the room, I said to him, “Are you having any nightmares?” He said, “No, no, I’m not having nightmares.” And then when I saw him on his own he said, “I’m having really bad nightmares.” I said, “That’s interesting, you didn’t mention that earlier.” He said, “No, if I talk about it in front of mum and dad they get really cross or really sad, so I don’t mention it in front of them.” Sometimes young people will hide their symptoms from the parents and sometimes from themselves as well.
Can parents or grandparents hurt a child without meaning to?
For some people it can be a real revelation to realise that their parents are flawed, imperfect and make mistakes. The more people are able to think and talk that through, the better. I hear countless stories of parents who, as they are getting old and realising their own mortality, go back to their children and say, “I need to apologise, and to explain what was going on and why I did what I did.” It can be incredibly powerful for people to hear an apology even decades later. It can really help the person to change the meaning they make of what their parent did.
Some children are born and raised in the toxic environment of war, or have murderous or terrorist families. Does this inevitably traumatise them, or do they accept it as their life and what they know?
Without a doubt those sorts of ongoing chronic repeated experiences can be incredibly traumatic. Sometimes we psychologists talk about complex traumas, which are events that are ongoing – so not a one-off: during childhood – and interpersonal. It seems that these complex traumatic events tend to be more difficult to get your head around and more likely to cause long lasting difficulties. A lot of my work has been with children where one parent has killed the other, and that normally comes on the back of a long history of domestic violence, so they’ve grown up in this high level of conflict. They don’t feel safe. They hear the people they love arguing, and then eventually one of them kills the other.
How does a child react to such a monstrous thing as seeing or hearing the father kill the mother or vice versa?
Some of them can’t believe it, and don’t believe it. They just will not accept it. Even when the evidence is overwhelming. Some of them are furious with the murderer. Some are able to forgive them. Sometimes my job is to work out if they should go and visit the person who’s now in prison. The last time they saw them they were in this literally murderous rage, and it’s terrifying to think they’re out there somewhere in the world, but if they go to the prison and have to go through all those levels of security, and then they meet their parent who is now no longer in a murderous rage but actually much calmer, and if that person is then able to say, “Do you know what, I’m really sorry for what I did. As you know, we had a lot of arguments on that night. I was drunk (or I’d taken some drugs) and I hurt your other parent so much that the doctors couldn’t make them better. What I did was wrong and that’s why I’m in here.” Sorry doesn’t cover it, but that explanation can really help a child to begin to make sense of and begin to get through what’s happened.
Do children and adolescents sometimes become furious and full of the desire for revenge?
I worked with one little boy whose father was killed, and he was so obsessed with revenge that he couldn’t start to be sad and grieve the loss because he was planning how he was going to kill the person when they came out of prison. That’s what he was obsessed with. It gets really complicated, because my job then was to help him with that set of feelings and the traumatic loss so that he could then be sad. He was too set on revenge to be sad about the loss of his father.
When wars happen how do children react?
War has an incredible potential to be traumatic for children. It’s an incredibly potent cocktail of aspects of traumatic events that all combine together. First of all, if you’re a child, it’s during your childhood. It is not a one-off event. It is something that is ongoing over days, weeks, months, years even – and it’s interpersonal. Other human beings are responsible for this event. So it’s got all those elements of what we call complex trauma. In addition to that, it usually involves acts of extreme violence, life threats, bereavement, and it has an ongoing lack of safety, so the danger might be inescapable and not something you have any control over. There’s often a great deal of subsequent disruption. You might be completely displaced. You might be having to find somewhere that is safe enough to sleep for one night.
In war there is a great deal of not only trauma but also fear?
This ongoing fear is often at the root of some of the trauma. War is really bad for children overall. The trouble with trauma is that people learn the world is unsafe, and then they take that learning with them as they go forward. So how do they ever feel safe? They’ve learned just how unsafe the world is, and they might have symptoms that slide in: intrusive memories where you have sounds, flashes and sensations They might find themselves unable to sleep, because they are now on this higher level of alert so they can’t sleep. They can’t concentrate. They lose their temper really easily. Older children, adolescents, might become really obsessed with the injustice of the world they experience. If they’re on this higher level of arousal of risk, then it might look like they can’t pay attention. I work with some children who might have a diagnosis of attention deficit hyperactivity disorder (ADHD) because they’re sat in the classroom and they’re constantly looking around and not looking at what the teacher’s trying to teach.
After the Second World War for quite a long time nobody wanted to publish the books Primo Levi and Elie Wiesel wrote about concentration camps because nobody wanted to know?
You have these different levels of avoidance or suppression. At an individual level you might have an immediate ecosystem around the person who maybe doesn’t want to know about it for whatever reason. They don’t like to see their child upset, it’s distressing. Sometimes you have a bigger system, like the political system that also silences these stories and feeds the trauma and keeps it going, because people are explicitly told not to talk about what happened, so they don’t get the chance to process the memory or to change the quality of the memory.
“As a therapist, my work is regaining enough trust for them to be able to share the details of what happened.”
David Trickey, what about when terrible accidents happen such as the recent fire in a nightclub in Switzerland. A young person dies and his best friend doesn’t. How does the loss of someone who is their friend or their brother or sister affect them?
Sometimes people talk about survivor guilt. They feel guilty that they are the ones that were spared when someone right next to them is the one that’s killed. It can be incredibly difficult to make sense of that, partly because it’s such an awful thing to think about. Now, if you want to really understand why they died and you didn’t, it might be just luck, but to come to that conclusion you have to think through what happened and the trouble with trauma is that people avoid thinking through what happened because it’s so awful. My job as a therapist, but also parents can do this, other people can do this, is to help the young person to think it through, awful though it was. Rather than them sort of throwing it in the back of their mind and it keeps falling out. My job is to help them unpack it. Look. Talk it through. Think it through. And then we can put it back. We’re not changing what’s happened, but we’re changing the meaning that they make of it. With traumatic memories, we need to take hold of them.
How do parents react to the death of a child?
The death of a child is almost by definition traumatic because it assaults the way the world is supposed to work. People assume that old people die first and young people will die when they become old. Parents assume that their job is to keep their children safe. So when a child dies it really shatters those assumptions they have of the world, and it can be really difficult to think that through and to explore what really happened and why, and to attribute blame and responsibility appropriately. As a therapist, what is particularly interesting is that guilt doesn’t usually respond to rational argument.
If a bomb bombs your building and the child dies it’s certainly not your fault.
Absolutely, but simply telling a parent that doesn’t seem to help or to change their thinking. It takes a lot of time to really get alongside what’s happened and to be able to think it through and begin to just chip away at some of that immense guilt that parents feel. My experience is that guilt and trauma are often linked very much when it’s a child that has died.
Is there an increase in child trauma?
There’s an increase in the recognition of it, and a decrease in the avoidance. We’re more prepared to talk about it, to look for it, and to help people with it. In the past, it was, oh don’t worry, stiff upper lip, don’t talk about it and it’ll go away. And in fact, it didn’t go away. We used to have a society with rules where we didn’t talk about it, whereas now society is changing and we’re getting better at identifying the problems, looking for the problems and then providing the support. I don’t know if children are more traumatised than they were, but I do know that we’re better at making it something we can talk about and something that we can help with.
Maybe before people were paying much less attention to this kind of thing?
Yes, and just as we are better now at talking about trauma and looking for it and helping people with it, we also sometimes think about post-traumatic growth. That’s not to say that it’s good that these things happen, but sometimes there are things that will drive a person forward. Somebody might for example become very active and want to change the law about a certain thing because of their traumatic experience, and that will be a real driver for them and something good will come out of it. Or somebody might start to appreciate their relationships and start to engage more with people and do more meaningful things because they’ve realised how fragile life is because of what’s happened. I’m not in any way saying that trauma is good for people, but I am saying for some people following potentially traumatic events there’s also some post-traumatic growth for them.
Is racial prejudice also very traumatic?
Racial prejudice has such a traumatic potential because those events are something about who you are and how safe you are and how you are seen by the world. For example, when I was 14 years old I was beaten up. I was in the wrong place at the wrong time, and I recovered pretty well psychologically. I have a friend who at the same age was beaten up, but he happens to be black. The meaning that he made of that same event was very different. He was beaten up because he was black, and therefore it has the potential to be more traumatic because this event means that as a black man you’re not safe. You will be picked out when you’re walking down the street. So the same event, but with different meaning, making a very different impact from a trauma point of view.
What about trauma resulting in attention deficit hyperactivity disorder (ADHD)?
Sometimes we misdiagnose or misunderstand the difficulties. Some children look like they’ve got problems paying attention, but actually they’re very good at paying attention to potential threats. Whatever the teacher is teaching them probably isn’t a threat, but: What are those children doing behind me? And: What was that noise in the corridor? And: What about in the playground? I’ve learned that the world is unsafe so I need to keep an eye on these things. It looks like they can’t pay attention, but actually they’re very good at paying attention; just not to the things that we want them to.
Is to be raped or sexually abused another common big trauma?
Yes, and it’s now more talked about, which is a good thing. There are many things that are traumatic about that, because it’s such an intimate act that ends up being something awful – and it’s with someone often that you should be able to trust or that you did trust and then it turns out that you can’t trust them. It challenges a lot of our assumptions about the world and about ourselves. Society has a role to play as well. Sometimes society will ask questions in a way that the person who has been raped will say, I’m being judged, they think it’s my fault, and then they feel they can’t talk about it. As a therapist, my work is regaining enough trust for them to be able to share the details of what happened.
In therapy is it essential that people tell the truth?
If they want to process what happened to them, they need to be able to tell me or tell someone what it is that actually went on. If the event is about not being able to trust other people, it’s really difficult. One of the other balancing acts in therapy is if the event has been another adult making the person do something they don’t want to do, I need to be really careful that I don’t recreate that in therapy. I need to make sure I do not become another adult making them do something they do not want to do. My job is to give them all the tools or the information, so they can make a well-informed decision about what to do within therapy.
In your long experience of practicing therapy do you sincerely have the impression that you really do help your patients?
Yes, I have knowledge that they can benefit from. Sometimes people are able to tell me what happened to them when they haven’t been able to tell other people. That changes the quality of the memory, and it changes how the memory interferes with their life. They are then able to go on to reclaim some of their life.
How far can you help them?
I get to be there whilst they do the work, I can’t do it for them. I’m like a mountain guide where I can help them through this journey. I certainly have been doing this long enough to have watched some amazing, inspiring young people. Sometimes we talk about resilience in a way that suggests that if a child is struggling, then somehow they weren’t resilient enough. I really struggle with that use of the word because the children I work with are some of the most resilient people that I know. They’ve lived through extraordinarily traumatic events and yet they’re still showing up, they’re still working hard trying to reclaim their lives and their future. To me, that’s real resilience, and I see it as a real privilege to be working with them. Things really can change, given the right sort of support.
To give up smoking it has to be you who wants to do it. Is it the same in therapy for traumatic experience?
It’s the same in that the motivation is key, absolutely crucial. I can’t do it for them. I can give them the information. I can describe what the process will look like, but they have to do it themselves. There’ll be some young people who’ve got awful post-traumatic stress disorder (PTSD) and they can’t sleep and they’re having flashbacks and they’re having nightmares and they’ve dropped out of school. I explain what therapy would look like, I explain how it might work, I explain the results, and they still are unable to do the work or are still not quite ready or willing to think through deliberately what is that has happened because it’s so awful. So then I have to say, “Okay, it’s your choice. You’re in control. You weren’t in control when that traumatic event happened to you. But you are in control of this relationship and of this.” Even if I haven’t helped them to process the trauma, I’ve given them an experience where an adult is giving them the control and doing them the service of allowing them to make decisions, and that begins to chip away at some of their assumptions that they learned in the trauma.
How long does your therapy work with a patient last?
I normally would do about one hour at a time, although sometimes we have longer or shorter sessions. On average, we’re talking about 20 sessions, but that’s a broad range. It can take longer because I’m having to regain their trust. They’ve learned not to trust people. When I look at the big randomised controlled trials we have, they’re looking at around about 11 sessions to do some really useful work, but they’ve got a head start on me because their participants have signed up to be part of the trial so they’re much more therapy ready. Some of the young people I work with, they say, “Well, we’ll give you a go. We’ll give you a few sessions and see if we like you.” And then it takes a bit longer to really gain that trust. There’ll be some that I see for many more than 20 sessions.
In your career have you sometimes had disappointing failures?
Sometimes there’s people that, however hard I try, still are unable or unwilling to come to me and tell me or talk through what happened. It makes me sad because I have a lot of faith, and the evidence would back this up and my experience would back it up, that this sort of therapy can be incredibly effective for many traumatised young people. But for some people, it’s just too frightening to think through what happened. And then there will be some where they do it and it doesn’t work. It doesn’t work for everyone. Fortunately, I’ve always been in services where I’m allowed to keep going and I haven’t had an experience where it seemed like everything was okay and then it suddenly went bad again. I don’t just have a certain number of sessions, so I can say, “Okay, that didn’t work. Let’s try something else. Maybe it’s a different person you want to see or a different type of therapy we need to try.”
Are you optimistic that trauma can be removed in a life or at least mended?
Yes, I’m optimistic that we can really help people to make sense of their experiences, to process the memory so that they can reclaim some of their life. We can’t remove the trauma, and actually, most of the young people I work with, it’s their experience, and they don’t want someone to pretend it didn’t happen. But they don’t want it to be getting in the way of the things they want to do. We are getting better at helping people to process the trauma. In particular, we’re getting better at engaging people and working out how do we use this therapy for different types of people who see the world in different ways and who think in different ways. We often talk about neurodivergence and we’re better at adapting the techniques we have to different types of young people. I’ve been very fortunate in my career in that I’ve been able to specialise in trauma for a very long time now, which means I’ve learned more and more about less and less. I’ve become very focused on this area. I always prioritise my own clinical work, so I do a bit of teaching and some supervision, and I do research, but mainly I’m doing the work, which means I get to learn so much from the young people. I learn from the research and from other experts, but mainly I learn from the stories the young people tell me, and they’re able to give me feedback. They say, “Well, when you talk like that, that doesn’t help. I prefer it when you’re like this with me.” I learned so much from the young people. It’s a genuine privilege.
David Trickey, thank you so much for this very interesting conversation.
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