Dr. Karen Treisman talks to freelance journalist Jo Carlowe discussing areas of trauma and trauma enforcing models, parenting, adversity (ACE’s) and attachment, and using a range of creative therapeutic approaches with families.
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Dr. Karen Treisman is a Highly Specialist Clinical Psychologist who has worked in the National Health System and children’s services for several years. Karen has also worked cross-culturally in both Africa and Asia with groups ranging from former child soldiers to survivors of the Rwandan Genocide. She also is the author of 8 books, including the bestselling book, “The therapeutic treasure box”, and of 3 sets of therapeutic card decks.
Karen has extensive experience in the areas of trauma, parenting, adversity (ACE’s) and attachment, and works clinically using a range of therapeutic approaches with families, systems, and children in or on the edge of care, unaccompanied asylum-seeking young people, and adopted children. Karen also specialises in supporting organisations and systems to move towards becoming, and to sustain adversity, culturally and, trauma-informed, infused, and responsive practice. (bio via Safe Hands Thinking Minds)
Interviewer: Hello. Welcome to the ‘In Conversation’ podcast series for the Association for Child and Adolescent Mental Health, or ACAMH, for short. I’m Jo Carlow, a freelance journalist with a specialism in psychology. Today, I’m interviewing clinical psychologist, Dr. Karen Triesman, who is an expert in the areas of trauma, parenting, adversity and attachment. Karen has worked both in the NHS and internationally. Karen, thank you for joining me. Can you start with an introduction about who you are and what you do?
Dr. Karen Triesman: Yes, sure. Thank you for having me. So, yes, I guess just building on the introduction that you just did, so, I’m a psychologist. I work in lots of different ways. So I work therapeutically, predominantly with children and their families who’ve experienced relational and developmental trauma. So, in adoption, child protection, foster care, asylum-seeking young people, but also do a lot of court work, as well as supporting a lot of different organisations, like social services, schools, prisons, residential homes, to think about how I can support them organisationally to become more trauma culturally and adversity informed and responsive. So lots of different levels, but all around the areas of trauma.
Interviewer: Karen, you’ve worked with relational and developmental trauma in children and adolescents in some very diverse settings. What inspired you to take on this work?
Dr. Karen Triesman: Lots and lots of different things. But, I suppose, for me, this sort of work connects all of the areas that I’m passionate and interested about. So it connects things around people’s identity and intersectionality of that, it connects social justice and human rights, it connects things around systems work. So thinking about not just working with families and carers, but also about systems from schools and social justice and social services. It also allows you to be super-creative. So all of those things felt like they came together in the area of relational and developmental trauma. But also I had loads of psychologists who inspired me on the way, who worked in this area. I worked in a residential home when I was at university. My children-in-care placement was my favourite one during my doctorate. And I guess, personally, I had grandparents who were in The Holocaust but then moved to apartheid South Africa. I’ve spent a lot of my time in Africa. I have a mum with multiple sclerosis. So I think lots of those different things shaped me to want to be in the area of trauma.
Interviewer: Right. Let’s talk about some of that international work that you’ve done. What are the benefits of cross-cultural work?
Dr. Karen Triesman: Goodness. So, so many benefits. And I think it’s a real privilege to be able to do that sort of work. And if not in those countries, then working with people within the UK who come from different countries. But I suppose, for me, there’s that area of being able to be really creative and resourceful. Making tools and games out of sticks and having to work in areas where there is no child protection or safeguarding in place, and really thinking out of the box.
I think there’s a huge thing about reflecting on your own privilege and your own power, and thinking about that intersectionality. So not just country, but someone’s religion, spirituality, sexuality, age, gender, and thinking about humility in that makes you think a lot about some of our ethnocentric models. And as a clinical psychologist, lots of our models come from Western ideas. So I think that’s really useful.
I think you also just get perspectives about how different systems work. But also just really interesting bits about cultural idioms and representation. So, things like epilepsy in the UK, we see often as a neurological disorder, but in many places in Africa, it’s seen as from a spiritual point of view or seen as messages from ancestors. So I think it opens your eyes to thinking about the world to nature, to other beings, to spirituality. So that’s super-interesting.
As a clinician, I think it makes you think really carefully about the words we use, how we communicate the language. But everything is different cross-culturally, from child development, what we see as a teenager compared to what they see as a teenager. How we express emotions. How we parent children. The power of community. And I think, my goodness, now, more than ever, that’s important. As they say, it takes a village to raise a child. But just lots of beautiful things. The beauty of music and rhythm and Tai Chi and connection to nature.
So, yes, I think there’s a huge amount about working in those sorts of settings that we can draw and think about. And it gives you a lot more ability to think about people’s kaleidoscope and different lenses that people look at the world through, that can sometimes be lost when we see people in very homogeneous, reductionist ways.
Interviewer: Right. It sounds really, really rich, I must say. As you mentioned earlier, you also work with children on the edge of care and with unaccompanied asylum-seeking young people and adopted children. What common themes arise when working with groups in different contexts?
Dr. Karen Triesman: So I suppose, obviously, there’s lots of differences. And how you would work with a child, for example, on the edge of care, who was British-born, compared to an asylum-seeking young person, will have huge different considerations, and there’s no recipe book for how to do that. But I think there are some really common themes. I think the sense of injustice and powerlessness and feeling done to. I think that is across those areas. So how we increase a sense of voice and influence and choice and collaboration. I think that’s really common. Obviously, the experience of trauma. Loss and grief. I think all of those children in those different areas have had a degree of goodbyes and loss and grief and change and transition. What else? Identity. Huge amounts of who am I? Where am I going? What am I going to do? Around spiritual, moral identity and physical identity.
I think there’s commonalities in terms of societal discourses. They’re groups who people can often judge or stigmatise or can be misunderstood or neglected. But I also think there’s lots of commonalities in that, as a therapist, the core values and skills that you would use are very similar to increase safety and stability, to be nurturing, to be containing, to think about emotional and physical regulation, to really listen, work with the team around the child, to be really multi-sensory, to be really nourishing. I think, actually, those core therapeutic qualities transfer and remain the same amongst those groups. I’m sure there’s lots of others but those are off the top of my head.
Interviewer: Let’s talk about your clinical work, then. You use a range of therapeutic approaches. Can you describe some of the methods that you use?
Dr. Karen Triesman: So, I guess, I work very eclectically and integratively. I’m not someone who works in a purist way or is married to a particular model. So my core training was in clinical psychology, and I trained at Salomons, which really covered us in three main modalities, which were systemic, psychodynamic and cognitive behavioural therapy. But I have trained in a number of other approaches that I draw on. So everything I use a lot of creative and expressive tools. So whatever approach I’m using, I integrate clay, puppets, play, miniatures. But I’ve done further training in narrative therapy, which is obviously a systemic approach, which I absolutely love. In things like DDP, Didactic Developmental Psychotherapy. Theraplay. Some sensory approaches. EMDR. What else? Video interaction guidance. And then more on the story front, I’ve done some training in testimonial psychotherapy, narrative exposure therapy and therapeutic life story work. So I guess, I draw on lots of those, and I very much… It’s given me lots of tools into my treasure box. But I’m very much guided by what the person presents with rather than trying to fit them into a particular modality.
Interviewer: Let’s talk about the treasure box then, because you’ve authored eight books, including the best-selling ‘The Therapeutic Treasure Box’. Tell me a little about this. Who is it aimed at?
Dr. Karen Triesman: Yes. So ‘The Therapeutic Treasure Box’, well, it’s absolutely my baby. It was the book that I wished that I had when I qualified. And that’s how I wrote it. So, in essence, it’s got thousands of direct tools, techniques, photocopiable worksheets, examples of ways to work, not just with trauma. Ways to increase children’s safety, to respond to outbursts, to think about nightmares, to support endings. So it really is a treasure box of ideas and tools. And I wrote it specifically, really, for social workers, therapists, psychologists and practitioners, in general, although I have to say. Although I’ve got more specific ones for parents and carers, I’m regularly told of people using it who are residential workers, youth workers, parents and foster carers. And I also have had lots of adult survivors of trauma telling me that they use it and have found it really useful. It’s massive. It’s a kilo in weight. So it is a big book. But, yes, in essence that was the audience. I really wanted to take some of the ideas of neurobiology, of sensory attachment, of trauma, of dissociation, but then really marry them with practical tools and techniques that can be interwoven in lots of different approaches.
Interviewer: Great. I’ve heard you suggest that instead of asking people, what’s wrong with you, we should ask and be curious about what happened to you. Can you tell me a little bit more about this idea?
Dr. Karen Triesman: Yes, sure. So I suppose that’s actually a question that came from Joseph Foderaro in 1991. He’s often not referenced, so I always want to cite him. And it’s more of a philosophical stance rather than a specific question. But in essence, what its meaning is, rather than having a deficit model of what is wrong with you and very problem-saturated, it’s trying to have a sense of what’s happened to you? Who are you? What’s your story? It’s that sense of it’s not what is the matter with you but what matters to you.
And with that, it’s really about, on an individual basis, how can you see the person, the whole person, behind the behaviour, behind the label, behind the crisis? How can we see the person within the landscape of their experiences? Re-contextualize them within their context. And how can we actually think about the meaning-making and the sense-making of the behaviour? How can we see the behaviour as just the upper layer, but we’re not seeing all the layers underneath?
And I suppose the extension to that is, why has it happened? So thinking about the wider context, the political climate, the economic climate, poverty, social pressure, but then also applying it to us, as organisations and teams and society. And that feels very apt at the time we’re talking about now. What is happening to us and why, at a societal level, and thinking how can we be curious instead of furious? How can we really think about, what are these behaviours trying to communicate and tell us? How can we look at what their function is, what their meaning-making is? And to try and get an understanding, rather than just putting a plaster over a gaping wound. And the real individual that no one size fits all.
Interviewer: Right. And I would imagine taking that stance makes a real difference to how people practise.
Dr. Karen Triesman: Huge. Huge amounts. And it’s massively important that we’re not seeing people as numbers or statistics or labels, and really being curious, because there’s so many different reasons why people do the things they do. And often they are about survival and coping skills. So, yes, it can make a huge difference. And for your colleagues, when your colleague or team is responding in a particular way, how can we also try and understand that, rather than going straight to being irritated or annoyed or confused by them.
Interviewer: You’ve previously stated that you have a huge passion spreading the word about attachment and trauma. The idea being that, by creating rich environments of awareness, it will have a ripple effect on public health. Can you elaborate on this idea?
Dr. Karen Triesman: Yes. It’s a big question that. So I guess, there’s lots of different levels. On one level, for me, my biggest passion and dedication is about creating whole, system-wide change in our communities, in our organisations, in our systems. And so, how do we actually make the systems more adversity, trauma and culturally informed, infused and responsive? And how… There’s a quote by Alexander Heijer which says, if a flower doesn’t bloom, you don’t try and fix the flower, you change the environment in which it grows. And, for me, spreading that knowledge is so that people can start to invest in creating systems that are nurturing that are reparative, that are therapeutic, that are healing. And that are trauma-reducing instead of trauma-inducing. But how can we create preventative, proactive systems instead of crisis ones? So that’s that end.
The other is about how can we recognise the lots of different types of trauma? So, not just trauma of the individual, but community trauma, intergenerational trauma, organisational trauma. And I think the more I can spread that, the more we’re going to be able to think about responding and addressing some of those things. And hopefully increase people’s compassion and empathy. But I think it’s also about getting the knowledge on a wider. So why, for example, do pregnant women have NCT classes, but nothing’s mentioned about brain development or really going into attachment? And, so, why does Eastenders cover these things or Hollyoaks? How can we get knowledge out there that enables people to have some of the skills to be able to respond to it and to understand it and to support each other more as a community?
So I guess those are some of the reasons why I really want to get it on a wider level. And there’s not enough therapists to go around. We need to have policy changes and systemic changes. I truly believe that change happens far more in relationships than what it can do in an hour of therapy. So how are we creating the systems around to support those changes? And hopefully to prevent and reduce them from occurring in the first place.
Interviewer: So are there any specific policy changes you would like to see happening to allow that idea to spread?
Dr. Karen Triesman: Yes. Don’t get me started on those. Absolutely. There is a huge amount. I’ve actually just written a book chapter on that for my next book. Yes. Massive amounts of policy changes around making systems more trauma-informed. But also looking at wider policies, such as early intervention, such as thinking about some of the campaigns we do, such as thinking about our diagnostic system and some of the changes I think needs to be done to that. So, yes, huge, huge amounts. And lots around the root causes. So how are we thinking about poverty, racism, social oppression? So, yes, I think, in terms of intergenerational changes, we need to be thinking much more politically and systemically to make real, lasting changes that change the fabric of our systems.
Interviewer: Right. Are you optimistic that will happen?
Dr. Karen Triesman: I’m ever-hopeful. I think that we are making changes, but I think we need to do a whole lot more. And change is scary for people and threatening for people. So I think it’s going to take a whole lot of work and a collective movement and voices coming together. But I’ve certainly seen changes happen already. So I’m hopeful that they are going to continue to happen. If we look at other movements that have happened in the past, changes do happen. If we look at things like seat belts in cars and smoking, there’s been huge shifts that people probably never thought possible. So I hold onto those to anchor onto.
Interviewer: Right. Karen, under a Winston Churchill Fellowship Travel Award, you visited the US, to study whole-system and organisational approaches to trauma-informed and trauma-responsive care. Can you describe some of the new ideas that you’ve brought back with you following this trip?
Dr. Karen Triesman: Yes. It was a mammoth trip. And I have to say, that’s probably one of the best things, professionally, I’ve ever had the privilege of doing. So there was so much. And that is actually the topic of my next book. It’s hard to put it into a few points. But I suppose, first, what I’ll say is, two of the best things that came from it was the connections and people that I met. And I think that’s huge, is how can we be a collective voice? So I think that was a massive thing. And also just giving me some time away from my very busy life here, so that I was actually able to think and reflect and process and create some of the ideas that I was thinking.
But I think some of the stuff that I was really struck by, because, obviously, I was doing the work already, so it was really to learn from other models, was a lot around the importance of interweaving ideas of trauma with culture, which I think we have lost sight of in the UK at the moment. I think America, particularly, are much better than us, in general, of creating very accessible, visual ways of communicating complex information. So through their infographics and animations and those sorts of things.
I really got to see the values and the principles of trauma-informed practice, from safety to collaboration to co-production to strength, in practice, in prisons and schools and hospitals, and think about what does that mean actually to all the different organisational areas? So how does it mean to have a trauma-informed supervision or trauma-informed team meetings or trauma-informed physical environments? And what I’ve done, I suppose, is try and get all of those different ideas from the over a hundred visits I had, take all of those, mix them with all of the ideas I have, with the over 90 organisations I’m working with now, and bring those together. And that’s what I put in my training and in my consultation and in the book. Is to try and draw from best practice and add to that and not reinvent the wheel, I guess.
Interviewer: Right. And are people receptive to those new ideas, new ways of working?
Dr. Karen Triesman: Yes. Absolutely. I think, obviously, I am in a position where people are inviting me in, so I guess that’s half the journey. It helps! So I think people have been really receptive and open and engaged, generally. You’ve always got people, understandably, who are apprehensive or protective or feel quite challenged by the ideas. But I think, yes, I think generally there is a notion of this is something that’s needed. But also a sense of, this is a real journey and it’s going to take a lot of hard work and effort and resources. And that can feel quite overwhelming for people. So a lot of what I’m doing is helping people really think about their specific context. What can be done realistically? What needs to be done to support you on the journey? How can we do it in a meaningful, slow way, rather than trying to rush and change everything in a very tick-box way, but it’s not going to be sustainable?
Interviewer: Right. Karen, what else is in the pipeline that you’d like to mention?
Dr. Karen Triesman: Well, things are probably slightly up in-the-air at the moment, because with the current situation, I imagine things are going to change quite a lot. But I do have quite a few things in the pipeline. So I’ve got another set of cards being released in May, which is super-exciting, called the ‘Parenting Patchwork’. And they are really to help, predominantly social workers, therapists, but many others, to do things around understanding the impact of trauma and attachment on children’s development. They’re to help with parenting capacity and foster care and adoption assessments. So that’s super-exciting. They’ll be out soon. My next book, which is due next week. So it’s very much done. I’m just doing the final touches, which is based on trauma, adversity and culturally informed, infused and responsive organisational change. Very catchy title, I know!
And then I suppose the other thing that’s been really exciting is around my children’s workbook. So I’ve been doing lots of whole-school trainings or whole foster care trainings on, for example, Presley the Pug or on Binnie the Baboon or on Gilly the Giraffe. And those I’m really, really enjoying. So, yes, I’m hoping to do more of supporting organisations, continuing to do the work I’m doing because I love it. But also, yes, going to think more about online and technology and those sorts of aspects. And try and make some more connections, research-wise, cross-culturally as well. So I’ve been in talks with people in Africa and Asia and South America about possible cross-collaborative research and organisational projects. So, really hoping some of those come to fruition.
Interviewer: Sounds really exciting. And if people want more information on some of the creative ideas, is there anywhere they can go for resources?
Dr. Karen Triesman: Yes, absolutely. So I’ve got my website which is www.safehandsthinkingminds.co.uk. Got loads of free resources and podcasts on there. I’ve run trainings all around the country on ‘The Therapeutic Treasure Box‘ and on the various children’s books. And obviously my resources are out there. So I’ve got ‘The Therapeutic Treasure Box’, five children’s workbooks, which are on topics ranging from self-esteem, emotional regulation, trauma, nightmares and sleep difficulties, and anxiety, as well as the cards. And I also am very, very active on Twitter and on Facebook. I’ve got a group, safe hands and thinking minds. And my name on Twitter, where every day I add new ideas, thoughts, blogs, blogs, and all sorts of things. So lots of ways to keep in touch.
Interviewer: Right. And at the moment, as we’re speaking, we’re in the middle of the Covid-19 pandemic, so I’m assuming some of those remote online resources will become increasingly important.
Dr. Karen Triesman: Absolutely. And I’m hoping to try and create some more. And if there’s specific ones that people would really like or feel they’d benefit from, please do get in touch. Because I want to be as helpful and responsive to people’s needs as possible.
Interviewer: Karen, finally, what is your takeaway message for those listening to our conversations?
Dr. Karen Triesman: Lots of things. I really would want people to think about the values of trauma-informed practice, and how can we infuse and embody them in the work that we do. But, for ourselves, currently, in the current situation we’re in, for people to think more about creative and expressive tools and techniques. So if you are someone who works in a very purist way, such as CBT, how can you bring that alive with more multi-sensory, body-based creative tools and techniques? And I guess to hold in mind things around the intersectionality of identity. And how do we really keep at the forefront ideas of poverty and social oppression and marginalisation and racism, and all of those things, whilst we’re in the therapy room? But how can we think beyond the therapy room and about community and cultural and organisational approaches?
Interviewer: Brilliant. Karen, thank you ever so much. For more details on Dr. Karen Triesman, please visit the ACAMH website, www.acamh.org, and Twitter, @ACAMH. ACAMH is spelled ‘ACAMH’.
This was a lovely, wide-ranging, thoughtful and feelingful contribution from Karen and I am grateful for it. Well done to her, interviewer, Jo and all at ACAMH for making this happen; and sharing accordingly.
An inspiring and clear presentation. I love the mix of approaches and body/sensory based activities. Also the importance of moving further into the community. I was wondering about young people sectioned because of trauma related self harm/eating disorders etc, frequently related to sexual abuse they have suffered. My experience with a young relative is that all the inpatient facilities rely heavily on heavy drug sedation and the use of barely trained staff. The use of a punitive style of ‘CBT’ reduces privileges and removes access to any classes or activities following self-harm or intense flashbacks that lead to struggles with staff. Do you have any materials suitable to suggest in this situation. I once did some energy medicine (Donna Eden) meridian tracing to reduce overwhelm for my friend and after I left they said she was ‘upset’ and banned any touch for the future, although hand massage really helps her with panic. I have written to so many experts and noone has ever responded!