Supporting Client Recovery with Trauma-Informed Care, Neuroplasticity, and CPI Training
The release of CPI’s 3rd Edition Training incorporates updated research on trauma and brain science. The following article has been revised from its original copy with these new insights in mind.
As a Certified Instructor, I coordinate and teach CPI’s Nonviolent Crisis Intervention® Training Program at my community mental health agency. Many of our clients, youth and adults, have a history of trauma. In my role as a licensed clinician, I’ve seen firsthand how the footprints of trauma can be long lasting and devastating.
Optimal brain development builds from birth onward with previous foundational aspects building to the next. Trauma interrupts that development. Think of a house without a solid foundation. Subsequent building on top of this foundation could also be incomplete. Soon one has an unstable structure on many levels. It may appear to be more like Swiss cheese with holes in key areas. Gaps in neural development may prevent one from mastery of age-appropriate developmental milestones and being able to connect with others. As one continues, they may fall farther and farther behind their contemporaries. This in turn may lead to being less equipped, isolated, and possibly scapegoated.
But there is hope.
By employing trauma-informed care, the power of neuroplasticity, and concepts taught in CPI’s latest edition of training, we can support the needs of clients and help them create new and better pathways in the brain that lead to healing.
How Trauma-Informed Care Supports Recovery from Trauma
Trauma-informed care is defined as a framework of thinking coupled with planned interventions that are directed by a thorough understanding of the profound neurological, biological, psychological, and social effects that trauma has on an individual, while also recognizing that person’s constant interdependent needs for safety, connectedness, and ways to manage emotions and impulses.
By adopting a trauma-informed approach, you can develop meaningful connections with your clients and create a safe environment for them to grow and heal.
One way trauma-informed care can help is that it increases empathy and understanding for the clinician. It helps us to see the client as someone needing support rather than someone acting out by remaining in our logical, rational brain instead of being pulled into our emotional one.
Those with persistent mental illness generally have a history of trauma. It’s no surprise that they may have and currently use behaviors to cope that have alienating features. Dysfunctional behaviors that were employed initially may have worked on some level during the initial abuse but not now.
Trauma-informed care also helps build trust in the relationship between the client and clinician. Clients with a history of trauma often do not have a history of strong or healthy relationships. But staff consistency and reliable care helps to create opportunities to begin to develop healthy relationships.
Having trust in staff and the environment can begin to get the client out of their head, deemphasizing past neurological paths and creating new ones. Staff can facilitate this growth by taking a mindful, person-centered approach to trauma-informed care when clients are in crisis. It can set the stage for more effective, safe coping with the volatile and intense emotions that someone with trauma may experience. Ultimately, this helps to establish a course to recovery.
How Neuroplasticity Supports Recovery from Trauma
Numerous studies on the relationship between the brain and body confirm that what happens to you in life forms lasting neural connections in your brain. And those connections can impact and affect the quality of your life. Adverse Childhood Experiences (ACEs) are just one example of how scientists have been able to connect the footprints left by childhood trauma to mental and or physical health difficulties in adulthood.
Thankfully, there is a way to reverse the damage done by trauma. We can harness the phenomenon called neuroplasticity.
Neuroplasticity is the ability of neural networks to positively change through growth and reorganization.
As clinicians, we can help our clients build new and better pathways in their brains to give them a chance to identify, support, and practice positive coping skills—leading to more healthy outcomes.
This work requires being present and mindful, no easy task, but can mean hope for our clients. Thankfully, CPI’s latest edition of training provides workplaces like mine with the tools to stay mindful, trauma-informed, and in the moment when helping our clients build these positive neural pathways.
How CPI’s Crisis Development ModelSM Supports Recovery from Trauma
CPI’s 3rd Edition Training takes a deeper look at the Crisis Development ModelSM and trauma’s impact on behavior. The Crisis Development ModelSM has four distinct behaviors for staff to be aware of and provides four corresponding levels of support that can be offered to help. I’ll explore 5 ways you can use the Crisis Development ModelSM to support client recovery.
1. Help clients begin to identify and develop adaptive responses to anxiety.
First, it’s important to identify what is considered baseline behavior for your client. An individual who has experienced trauma may have a baseline that includes higher vigilance, difficulty with self-regulation, chronic stress, and other conditions that take one out of experiencing the here and now. Their baseline likely includes higher levels of arousal and anxiety than other clients.
When a client experiences anxiety, we can help them by offering encouragement and support. We can also reduce instances of anxiety by removing anything that might cause a client to feel distressed. As you get to know your client and their unique history, this will become more focused and easier to do.
Mindfulness and meditation are two ways we can help a client identify and develop positive adaptive response to their anxiety.
These practices can empower our clients to form new neural pathways that can lead away from the impact of trauma and instead toward recovery by helping them learn to self-regulate.
2. See defensive behavior as trauma-reactive behavior, not deliberate outbursts.
CPI training stresses that Precipitating Factors can often impact a person’s behavior. Present dynamics may be more accessible as contributory factors when exploring Precipitating Factors with a client due to the repression of past traumatic material. Repressed content is buried for a reason. As such, traumatic historical content can escape conscious awareness. In other words, past trauma can be the true driving Precipitating Factor. Knowing this can help you as the clinician stay rationally detached from the situation and in control of your logical brain.
If a client begins to demonstrate defensive behavior, yelling back at you, becoming agitated, it means you need to offer up very clear directives to help guide them to return back to their logical brain. You can do this by offering them choices and giving them the ability to take some control over what happens next.
If the client continues to lose rationality, they could become more agitated (fight) or withdrawn (flight) in a way that they do not seem present. Both conditions can be generated by re-experiencing the effects of the past trauma in the form of a flashback. Due care must be exercised as to not trigger further decompensation. Interventions must support the client’s return to the present in a way that can minimize the chance of explosive behavior. Remember the brain can’t always distinguish the difference between what is external (accepted reality) and internal (one’s own generated content). In other words, hallucinations / flashbacks can be just as real to the client as what is occurring in the here and now.
3. Discover triggers for a clients’ risk behavior by remaining rationally detached.
CPI training provides staff with a Decision-Making MatrixSM to help inform how to respond in the moment. It does this by plotting the likelihood and severity. Likelihood refers to the chance that a certain situation may occur. Severity refers to the level of harm that may impact the individual in that instance. When plotted together, the clinician is able to assess the risk or what the chance is of a particular outcome.
As you learn more about the client, you can adjust the matrix accordingly. For example, as you discover what triggers or negatively impacts your client, you can better understand the risk and know how to best respond.
By having a response planned in advance, you can remain rationally detached and offer the best support to the client when they are exhibiting risk behavior. Planned treatment can also minimize staff fear and anxiety.
4. Take a trauma-sensitive approach and pave the way for positive recovery during tension reduction.
When de-escalating a crisis, the goal should be to not only prevent the crisis from happening again, but also to reconstruct the neural pathways that previously triggered the behavior. You can do this by employing therapeutic rapport during the moment of tension reduction. This can be a vehicle to help clients recognize maladaptive responses in the aftermath of acting out, to promote new understanding, as well as to develop strategies to prevent future occurrences.
5. Always take the opportunity to debrief.
This is an opportunity for clients to actively and safely participate in their own recovery. As a staff member, planning focused debriefings can provide essential protection from secondary trauma, vicarious trauma, or the beginnings of compassion fatigue.
As a Certified Instructor, I encourage staff to not only use debriefing to establish a relapse prevention process for the client, but also to make sure that staff are on the lookout for secondary or vicarious trauma in the aftermath of a crisis.
Pairing CPI training with trauma-informed care and neuroplasticity results in clients who can plug into the world around them rather than withdrawing from it.
By taking a mindful, person-centered approach, you first help a client re-pave the paths trauma laid in their mind and, secondarily, you empower them to consciously engage in their recovery.
Learn how you can support positive change like this by bringing CPI training to your workplace today.
About the author
T. D. Loftus, MS, LMHC, is a Master Certified Instructor. With a Master of Science degree from Northeastern University in Counseling Psychology and a BA in Psychology from Boston College, he’s a Licensed Mental Health Counselor (LMHC) in the Commonwealth of Massachusetts and a quality management and compliance officer in a community mental health agency. T.D. is also a Reiki Master Level II and a Kettlebell Instructor through the International Kettlebell and Fitness Federation.