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Working With Traumatised Individuals using the Low Arousal Approach

Professor Andrew McDonnell discusses Studio 3's framework for working with traumatised individuals using the Low Arousal Approach which, alongside the work of service brokerage organisation LivesthroughFriends, can enable them to live independent lives in the community.

Image shows a black and white book cover of 'The Reflective Journey: A Practitioner's Guide to the Low Arousal Approach' by Professor Andrew McDonnell (2019)
'The Reflective Journey: A Practitioner's Guide to the Low Arousal Approach' (2019)

In my recent book, The Reflective Journey: A Practitioner's Guide to the Low Arousal Approach, I provide a number of anonymised examples of real-life practical work. The following case example of a young man called Adam (not his real name) gives a good understanding of how we place trauma-informed approaches at the heart of our work. The following extract tells his story:


‘The people we support may not necessarily be formally diagnosed, but they can still show a number of clear signs of trauma. Trauma can have an even greater impact on specific populations, although some of the evidence is limited. Mevissen and de Jongh (2011) point to evidence which suggests that people with intellectual disabilities are more likely to suffer from PTSD. Understanding the trauma process may sometimes involve a good understanding of a person’s life story. We can refer to people having ‘traumatic pasts’ in this context. For three years, I worked with a forty-four-year-old man named Adam who had a complex and traumatic history. This is his story:

‘Adam was supported by a staff team in a small community home. He had been labelled with a severe personality disorder, mood disorder and attachment issues. In his past, there had been several periods of hospitalisation, most of which were related to his difficulties coping on his own and a profound sense of loneliness. Adam’s current team found it difficult to emotionally cope with his ‘explosive rages’, which could be triggered by seemingly trivial things such as the post arriving with utility bills, or a reminder that a significant birthday was imminent. Adam could be arguing with you one minute and very quickly move on and appear quite calm. There were a number of past traumas which included being restrained by hospital staff and, on another occasion, being restrained by the police. Adam consistently made abuse allegations against others, often after he had been restrained. Eventually, Adam’s early life history was revealed to the team (the files had been sealed to respect his privacy). Adam had been sexually abused by a family member at age twelve. At fifteen, he was used as a child prostitute, with his Aunt acting as his agent. Adam had also witnessed extreme violence and experienced temporary homelessness on several occasions. As an adult, Adam rarely had contact from his own family and he would constantly tell people that he was lonely. Paradoxically, he also seemed to struggle to be around people for prolonged periods of time. His sleep was often disturbed. Though he never really spoke about why, he often woke up in the night, and some staff reported hearing him scream and shout “No!”’

Adam’s traumatic history was enough to explain the failure of many well-intentioned attempts to provide psychological interventions, ranging from CBT and dialectical behaviour therapy (DBT), to a number of attempts at various psychotherapies. The latter approach did have some success in terms of his own understanding of his behaviour. Adam consistently ‘burnt out’ staff teams, but things began to improve when they were given contextual and historical information about his life traumas. This helped individuals to understand his explosivity, as he was clearly experiencing what trauma victims describe as ‘flashbacks’. Sadly, Adam died of a very sudden heart attack. At the young age of forty-four, I believe that his death was caused by a combination of his difficulties in regulating his own arousal and the effects of long-term trauma.’

Image shows a man in the foreground with his head in his hands, clearly distressed, and a woman looking at him in the background compassionately.
Many traumatised and stressed people see the world as chaotic and frightening

I have worked with many individuals with similar profiles to Adam. The people that we are often asked to asked to develop community-based supports for have often been exposed to highly institutionalised specialist care. A core part of the Low Arousal Approach to managing behaviours is to train and coach supporters to ‘see the person, not the behaviours.’ The many Studio 3 collaborations with LivesthroughFriends do involve individuals who are highly traumatised and view the world often as chaotic and frightening. Experience has taught myself and my colleagues that time, patience, compassion and empathy, and of course supports such as Low Arousal Approaches, can ultimately help to reduce the stress of the person and their supporters.

Written by Professor Andrew McDonnell

CEO and Clinical Psychologist at Studio 3


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