Professor Gilgun draws upon research and theory on resilience, neurobiology, executive function, attachment, trauma, and self-regulation (NEATS) to present an integrated common factors model on work with families and children where the children have experienced complex trauma.  Professor Gilgun will make use of case study material to illustrate the application of these important concepts.

1. Common Factors
in the Treatment
of Complex
Trauma
Jane F. Gilgun, Ph.D., LICSW
Professor, School of Social Work
University of Minnesota, Twin Cities, USA

2. Topics
•Introductions
•Why a common factors model?
•Definitions of complex trauma
•Common factors in assessment
•Common factors in outcomes

3. About Me
• Professor, University of
Minnesota, Twin Cities, USA
• 30 Years of Hands-On Research
• Research is Case-Based
• Long Term

4. Why Common Factors?
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5. Overview
Common Factors
in Assessment & Outcome

6. Common Factors
in Assessment of Childhood Trauma
• Neurobiology
• Executive Function
• Attachment
• Trauma
• Self-Regulation

7. Common Factors
in Outcomes (preview)
•Personal Characteristics
•Relationships
•Treatment Approach
•Social Service Influences
•External Influences

8. Common Factors in Assessment:
Ecology & Social History
Historical Forces,
Culture, Values
Community Resources
Religious/Spiritual Institutions
Parents’ Work
School
Extended Family/Social Networks
Peer group
Family
Child
Social
history

9. Time for Comments & Questions

10. Common Factors
in Assessment

11. Definitions of Trauma
in Childhood

12. Trauma in Childhood
• Events that overwhelm capacities for coping
• Examples

13. Trauma in Childhood
• Events that overwhelm capacities for coping
• Affect children’s development
• Executive function
• Self-regulation
• Adults misinterpret signs of trauma
• Children cope with, adapt to, and overcome the effects of
trauma within the safety of secure relationships

14. Complex Trauma
• A series of events that overwhelm capacities to cope
• They are interpersonal within
• Families
• Neighborhoods
• Schools
• They can be societal, regional, international
• War
• Terrorism
• Social Displacement

15. Complex
Trauma
Sexual
Abuse
Physical
Abuse
Witnessing Rape &
Physical Assault of
Mother
Emotional AbuseEducational
Neglect
Physical &
Medical
Neglect
Emotional
Neglect
War, Terrorism
Forced Migration

16. Assessment:
Effects of Trauma

17. Assessment:
Immediate Effects
•Dysregulation
•Rewiring of Brain Circuits
• Trauma-Based Emotions Stored in Amygdala
• Trauma-Based Memories Stored in Hippocampus

18. Assessment:
Longer-Term Effects
•Issues with Executive Function
•Issues with Self-Regulation
•Consequences: Developmental Delays,
Regressions, & Other Difficulties
•Increased Risks for Physical Health Problems

19. Resilience
An Outcome

20. Resilience, an Outcome
• Interactions of Adversities/Traumas
• That Lead to Capacities for Coping,
Adaptation, & Letting Go
• Related to the NEATS, a Common Factors
Model for Assessment

21. Resilience, an
Outcome
•Children are resilient when they
have coped with, adapted to,
and overcome the effects of
trauma and other adversities.
•Secure relationships become
safe havens

22. Resilience & The NEATS
Capacities for Executive function
& Self-regulation develop from
• Secure Attachments
• Adequate Neurological Functioning

23. Neurobiology

24. Definition of Neurobiology
• a branch of biology concerned with the anatomy and
physiology of the nervous system
• develops from interactions of genes and environment
• neurobiological systems are the foundation for how we
think, feel, and behave, while simultaneously, how we
think, feel, and behave shapes the workings of our
brains
.

25. Executive Function
•a term that covers a broad range of capacities
related to judgment, problem-solving, mental
flexibility, inhibitory control, organization of self,
anticipation of consequences, working memory,
and following rules and directions
•self-regulation a separate category in the NEATS

26. Video
InBrief: Executive function: Skills for life and
learning
https://www.youtube.com/watch?v=efCq_vHUMq
s

27. Attachment

28. Attachment
• behaviours that maintain contact with
care providers who serve as a secure base
from which
• to explore and to which to return under times of
stress
• also as a source of nurturance, love and
affirmation.

29. Attachment
• processes whose outward characteristics
change as children grow and develop
• Reciprocity & mutual regulation
• a source of love, nurturance, problem-solving,
affirmation, and even courage to try new things
and to persist when times are tough.

30. Secure Attachments
• Sensitive, Responsive Care
• Contingent Responsiveness
• Secure Base
• Safe Havens

31. Secure Attachments
• Inner Working Models
• Self-Acceptance
• Self-Rejection
• A Mix

32. Importance of Secure
Attachments
•Research shows that children can
recover from trauma and go on
to live satisfying lives if
•they have the safety of secure
attachments and if
•parents in turn have the
safety of secure attachments

33. Secure Attachments
• Self-Regulation
• Executive Function
• Resilience

34. Self-Regulation

35. Self-Regulation
capacities to manage and make sense of
one’s own thoughts, emotions, and
behaviors in times of stress and in the
course of everyday life

36. Self-Regulation
• Desired outcome
• An attribute of resilience
• Arises from secure attachments
• Safe havens can restore capacities for
SR

38. Attempts at Re-Regulation
Dysregulation
Human Agency/Automatic Activation of Schemas
Outcome
Pro-social Anti-Social
Self-
destructivei
Inappropriate
Reminder of Trauma
Search for Coping Strategies

39. Overall Goals
of Trauma Treatment
•High Road Responses
•Executive Functions
•Self Regulation
•Resilience

40. Mindfulness-Based Approaches
•Issues with EF and SR=a form of
mindlessness
•Logical response=mindfulness-based
practices

41. Common Factors
in Outcomes

42. Common Factors
in Outcomes
•Personal Characteristics
•Relationships
•Treatment Approach
•Social Service Influences
•External Influences

43. Foundational Common Factors
Model of Outcomes
Outcome
Extratherapeutic
factors
Relationship
factors
Expectancy
factors
Therapeutic
Model

44. Common Factors
in Outcomes
•Extratherapeutic Factors 40%
•Relationship Factors 30%
•Expectancy Factors 15%
•Treatment Model 15%

45. Present Model
of Common Factors in Outcomes
•Personal Characteristics
•Relationships
•Social Service Influences
•Treatment Approaches
•External Influences

47. Common Factors in Outcome
Historical Forces,
Culture, Values
Community Resources
Religious/Spiritual Institutions
Parents’ Work
School
Extended Family/Social Networks
Peer group
Family
Child
Social
history

48. What Research & Practice Tell Us
About Factors Associated
with Outcomes

49. Personal Characteristics:
Service Users
• Willingness to engage in Treatment
• More Likely When Service Users Have
Neurological, CD, and Health Issues under
Control
• More Likely When SUs Have Secure
Attachments

50. Personal Characteristics:
Service Users
• Genuineness
• Parents: Do Whatever it Takes
• Children: Find Treatment Innately
Rewarding

51. Personal Characteristics:
Service Providers
• Emotionally Available
• Attuned
• Secure Base
• Safe Haven
• Genuine, Warm, Unconditional Positive Regard

52. Personal Characteristics:
Service Providers
• Neurological Issues Managed
• Effects of Traumas & Adversities Managed
• Reflective Practitioners: Know their own hot
buttons
• Know what to do when hot buttons are activated

53. Personal Characteristics:
Service Providers
• Good EF
• See points of view of service users:
Empathy
• Recognize service users’ activations of
inner working models

54. Personal Characteristics:
Service Providers
• See multiple influences on service
users
• Good timing
• Use of resources
• Can let go

55. Personal Characteristics:
Service Providers
• Good SR
• Own neurological issues managed
• Own traumas managed
• Know when own anxieties activate themselves
• Remain attuned under stress

56. Personal Characteristics:
Service Providers
• Good SR
• Self-Care
• Reflective practice
• Mindful practice

57. Relationships

58. Relationships Between Service
Users & Service Providers
• Single most important factor in outcome after
external influences
• NEATS apply here
• How personal characteristics of service providers
mesh with personal characteristics of service
users

59. Relationships Between Family
Members
• Secure Attachments?
• Neurological Issues Managed?
• Good SR and EF?
• How much trauma?

60. Relationships Between
Collaborators: Systems Issues
• Attunement
• Capacities for Repair
• Good EF and SR

61. Applications to Treatment Modalities
• Effective Treatments
• Respond to the Elements of the NEATS
• For example: attachment corresponds to therapeutic alliance
• Mindfulness-based practice: SR and EF
• Reflective practice: SR and EF
• Ecological
• Developmental

62. External Influences
• Single most important factor in
outcome

63. External Influences
• Types
• Fortuitous
• Challenging
• Traumatic

64. Thank you