 Well, good evening everybody and welcome to tonight's webinar on trauma-informed care therapies and approaches to improve your practice. This is the second in our series of three webinars on trauma-informed care and I can reassure people who are already in the chat room. We will be explaining exactly what we mean by trauma-informed care. So welcome to the 432 people who are currently online and all the others who are watching. MHPN would like to acknowledge the traditional custodians of the land, seas and waterways across Australia upon which our webinars presenters and new participants are located. We wish to pay our respects to Elders past, present and future for the memories, the traditions, the culture and particularly the hopes of Aboriginal and Torres Strait Islander Australia. So Steve Trumbull is my name. I'll be facilitating this evening. I'm a GP by background. I've worked in a variety of city, rural and remote Aboriginal settlement or community settings, but primarily my career has been in medical education and I'm thrilled to be facilitating tonight's discussion. You can see our panel there. The biographies were circulated with the login information. So hopefully you've all read that and I won't waste time again through all those again because you want to have an evening of discussion tonight. But firstly, we do have Graham Pringle who you can see who's in Queensland, a youth worker. Now Graham, starting with you, you've recently submitted your thesis on adventure therapy as treatment for adolescents with complex trauma. Can you tell us a bit more about or tell us about some of the findings that you've had from that research? Sure, Steve. I won't go through the entire thesis. Everybody will be pleased to know. But what I found was complex trauma is quite different to complex PDSD and also to PDSD. They're all in the stress spectrum. Complex trauma is quite a different thing. So complex trauma is developmental in that the harms were done early in history. It's chronic and always involves failure of care somehow. So that means that young people and anybody at regards of ages come through a complex trauma kind of history will potentially have an unintegrated or disintegrated sense of self, which leads us into the dissociation literature. And in my rule of thumb is that half the young people we're dealing with are likely to be using dissociative responses to daily stressors as a normal thing for them. And that can obviously grow to be worse or it can wear off over time if they're in a safe enough environment. And the treatment that I found was most effective across all disciplines was rich experiences that featured deep care, voluntary participation and choice in what they're doing. Things that enhance and maintain their dignity and things that help them to understand their sense or who they are, their sense of self. And we don't necessarily need to go into discussing or exposing the traumatic memory that can be useful for some people who want to do that. You need to be a clinician to do that. I'm a youth worker. I can't talk about the past and memories and explore that sort of stuff. It just opens up and or is bought. So I provide experiences that provide care of voluntary enhance people's dignity and grow their sense of self. And that is quite robustly uniform across all the disciplines as being effective treatment. Thanks, Graeme. We're going to get a lot of conversation on that going when we get to that part of the webinar. I've just noticed that there's a number of people who seem to be having some sound problems in the chat room and the team is working very hard on this in the background. So we hope they'll get it sorted out by the time we get to the conversation part. But apologies for those who are getting correctly sound. This is something that we thought we'd eradicated and the teams working on at the moment. So hang in there, but we'll go now to Bethany. So Bethany, you're an occupational therapist and an art psychotherapist and you're also based in Queensland. Can you tell us a little bit more? Notice you've done some work on the HEAL program, HAL program. Can you tell us a bit about what that is? Yeah, absolutely. So HEAL is the home of expressive arts and learning. It was started in about 2004 at Milpera State High School in Brisbane. It's an art therapy and music therapy school-based mental health and wellbeing service. Milpera is quite a unique school. It's a place for newly arrived young people of refugee and migrant background to come and participate in intensive English learning and get ready to transition into mainstream high school. So there's kind of a two-pronged approach. It's obviously a lot about learning language, but it's also about settlement. And so the HEAL program supports the settlement of young people of refugee background who've come from often really complicated and traumatic journeys and using a whole range of creative methods. So we're really fortunate that we've got a dedicated space and being based in the school really helped us to overcome a lot of the barriers to access that a lot of young people of refugee background face in terms of accessing support for their wellbeing and for their mental health and that kind of post-traumatic growth that happens through that settlement phase. Great. Excellent. Thank you so much for such important work and such valuable members of the community. So thanks so much for that work that you do. I'm sure we'll hear more about that as well. And we also have on the panel tonight Matt Ball. Now Matt, you're a nurse practitioner and a psychotherapist. And you're also nationally and internationally recognized as an author on what you've called the Dissociocotic Framework, which I must admit is not something I've heard of before until I met you. So perhaps you could tell us all just a little bit more about that framework, the Dissociocotic Framework. Thanks, Steve. Yes, I mean, very briefly Dissociocotic Framework is a way of understanding what people might refer to as psychosis or symptoms of a psychotic disorder as a busy active dissociative response to threat in human relationship. And the relevance of that is that it invites the listener, the supporter, the nurse, the doctor, whoever, the peer worker to change their behavior rather than asking a person in distress to adapt their behavior. And the goal I suppose is that we can understand what people have for too long called psychosis as just yet another very understandable reaction to threat in human relationship and not this kind of sort of strange symptom of a psychotic disorder. So it's about understanding happens in relationship. And so I think it fits with the trauma-informed ideas of tonight. Well, it's really going to be useful tonight in the conversation. So thanks very much as the GP. I would love to know more about what's actually going on with people who are psychotic rather than just basically giving them that later and moving on. So that's fair. So thank you to the three of you. It looks like we're getting somewhere with the sound problem and people seem to be having a little bit of a better experience of the crackling. Anyway, we will push on and hopefully we'll get okay. There's a little bit of time now just while I run through some of the arrangements for this evening for those who haven't been with us before. The webinar platform is new, although some of you will have used before in other webinars. Can you please have a look at the three dots over there on the right on the purple bar that you use to access a whole lot of information. You'll find under the information tab, there are links to the resources that our panelists have submitted tonight and might put up for you to have a look at later. There's a survey on how things go tonight and we get feedback from you. And also there's a link to technical support if you're having trouble connecting or freezing or whatever, so you click on that. Most of you will have found the chat, the top right, the bubbles up there, the speech bubbles and 678 of you appear to have found that so far, which is great. There's also the opportunity to ask a question that will come through to us and we will try to formulate as many questions as we can into combined questions that address what you're interested in. So please click the speech bubble icon at the lower right of your screen if you want to ask a question and that will come through to that particular part of the website at our end and we'll watch that and put together some questions for the panelists that respond to what you're interested in. Now, this is a bit different tonight. This is the second of our three webinars relating to trauma informed care. This one does not have a case and it does not have PowerPoints, which is a blessing for many of us, not to have to sit through PowerPoints, but it's more about conversation. And I just want to make sure that people are aware of the learning outcomes so we can try and make sure that the questions in the conversation relate to what it is we're hoping people will learn from tonight. So the first is to outline the therapies and approaches that can improve practice when delivering trauma informed care and we will talk about what we mean by trauma informed care. We'll discuss the different stages of life where trauma can occur and how practitioners can support trauma through providing trauma informed care. And then finally, as which is really important for MHPN to discuss how to communicate effectively with other mental health practitioners to better support people affected by trauma. So, thank you to all those who submitted questions as part of the registration. We've been discussing and have decided how to start off the conversation and then we'll just, this is where it gets exciting. We just basically write it wherever it goes after the initial start. So let's just see what happens. We won't be able to cover all the questions that came in and there were absolutely plenty that were submitted in the sign up, but we will try and focus on core themes. And as well as I've mentioned watching the themes that emerge in the chat box and the questions that you submit through the portal as we go. So let's jump in. Now I'm going to kick things off. And I guess it's about getting down to the basics. I'm going to get a map first of all and ask Matt whether trauma informed care is actually a thing or whether it is really just another label that we're applying to being compassionate. I thought we'd jump right in with both boots here. Yeah, good. Well, yeah, the answer is yes, it is just another label to say no. Well thanks everybody for joining us. Yeah, no, I mean others will have other views. I suppose I can be dismissive at times of it being another label but I don't really mean it doesn't have a value. I think the dilemma is when it becomes a thing that we talk about rather than what we do as in being in relationships. So I think in my original trainings in psychodynamic and existential psychotherapy, I majored in working with trauma, but that was before we called it trauma informed practice. And what was that about that was about noticing what happens in the relationship and the changes in relationships that we can then practice in other relationships when there's been wounding in our lives. So I think it's not just another thing and it's just another label, but I think there's risks of, and I know we're going to come on to it later, but how do we discuss this effectively? Well, I think to avoid it becoming another label, the discussion effectively between each other, that being both a person in distress and professionals and then interprofessionally is how we probably protect it from becoming another label and say well actually the relationships between us all is what trauma informed practice will be about for me. Okay, great. Thank you for that. And Bethany, I'm imagining that the work you do, the relationship you strike with people from very different backgrounds must be key to how you then go about working with those people. Approaching different cultures, a number of people asking questions asked about approaching people who are refugees or who might be First Nations people or who might have an acquired brain injury or some other experience in their life. What are your thoughts about how to work with them being informed about what's gone on in their lives? I think there's a few parts to it and some of it is that you absolutely have to educate yourself about, you know, the kind of places and experiences that people are coming from and approach it with absolute respect and understand the privilege that it is to get to join and become part of these stories and form relationships with people with vastly different experiences. And I think really the lovely thing about working creatively is that it gives you a lot of scope to really let the young person or whoever you're working with really steer where the relationship goes and how it evolves and for them to really be the expert on their own story and being able to use really pick and choose from a lot of creative methods allows that young person quite a lot of control in the way that they kind of develop their identity in that space and their relationship with the therapist and the art making or whatever the creative activity is and it definitely puts them in the driver's seat and it allows them to really control how the narrative continues. And so you really get to learn. I mean, I've been working with young people of refugee background for about 17 years and I'm still constantly, constantly learning and then reflecting on other young people I work with and thinking, oh, that's probably what was going on there. You know, they always have so much more depth than we ever managed to get hold of just in that time. Absolutely. That sounds a lot like person centeredness I suppose and I must say we struggle with our medical students at the university I'm involved with in trying to point out to them that if they don't follow the narrative, they don't follow the plot or they lose the plot just sounds so important. And Graham, I'm imagining that in your work as a youth worker, you must do a lot of this as well. Trying to give people enough room to take a bit of risk and to try to direct things but your work in adventure therapy. Somebody's asked the question about why isn't that available through the NDIS it sounds like, you know, sort of a formal therapy. What are your thoughts about that? Well it is available through the NDIS but it's not a formal therapy. It's not recognised by the better access, etc. And also realise the complex trauma is not recognised in DSM. So we've got some issues around what is known and understood and things like that. Certainly youth work is about relationships but a little different from me to a clinician who works, who tends to work in a one-to-one in a room. I'm working one-to-one outside in a park with lots of other people. So there may be other people in the park who can be therapeutic in their relationships and interactions with the young person. There's only got a history of negative interactions. So I'm not looking at myself as being the key to the therapy but me helping a situation develop that is therapeutic because of the various things that are in it. And something that I thought might be useful again with the questions around trauma-informed care, Steve, is I was working with some people from Sudan and South Sudanese some years ago and we also had some young people in foster care on a camp in the same property and the Sudanese people wanted to run some farming and they asked what those young people were doing there and I explained that they're in foster care, their families have not been safe enough and they've gone into government care and they were horrified because in their view they were hurt by their government. They could always rely on their family and the idea that the caregiving would be so poor that you'd have to rely on government for them was just, they could not really get their heads around that. And I think that differentiates between a complex PTSD where you may still have good quality caring relationships trying to support you but lots of complicated things going on and complex trauma where you are an island and you are isolated from decent care and so you've got a qualitatively different experience of what it's like to be in the world. All right, great. Thank you for that. You did mention the word DSM or the term DSM. I'm just wondering if anybody has any thoughts about how comprehensively the diagnostic statistical manual or whatever it is covers this area and whether there are any sort of benefits or problems with that particular resource when we're working with people in a trauma informed sort of way. Matt, I think you're on mute, but you might have had some thoughts on this. There you go. Yeah, I think we know that. I mean, look, everybody's got an opinion. I think DSM is not fit for purpose is probably where I would start and it's not really intended as a criticism for that. But I think if I try and take myself away from my disapproval and discomfort with labelling people's human distress as a disorder and just say, well, I guess if we think about from a trauma informed care perspective, I think it has to be okay that people can value and use labels in their lives skillfully. And I think it can also be really important to me that we give people the knowledge and create a kind of epistemic justice if you like that people have the skills and tools and resources to describe and experience their own realities the way they want them. So I think one of the big dilemmas for me with the DSM is that it becomes a kind of sledgehammer. Resolve all, you know, Graham's talking about the better access scheme, which is ultimately based on disorders. The psychology and GP land is based on disorders. Unfortunately, the NDIS is moving towards it becoming easier to get a NDIS package if you have certain types of labels of disorders. So I think for me it's important probably to return it back to if we're going to listen to as Beth said about the person's narrative. Well, that might for them at this moment in their life include a disorder label. And from a trauma informed perspective, I presume I need to move with that narrative rather than telling them that it's not a disorder, it's probably possibly what I might think. But I just would add to that as well just go back to something Graham said. I really agree with him that the therapist is not or he's not giving the answers. I don't think therapy gives answers either. I think therapy creates a form of relationships which I imagine is what youth workers do as well. And I think it's helpful to kind of move away from the idea of hierarchy of therapies. I mean, you were doing that Graham, but I think that's all part of the DSM language is if you've got a disorder you need, you know, if you got schizophrenia, you definitely need a psychiatrist, right? In that, well, that's not true. You know, it's patently not true. And perhaps a youth worker is going to be incredibly valuable or perhaps a family member or a community member. So yeah, I think it's very, very complicated. And how do we return it back to being in relationship and a person having their own narrative and us working alongside that? I must say I remember back in the 90s being very involved in disability work and being taken to task by a parent that labels were for jam jars. When we were trying to figure out whether a child had autism or not. It does seem and it's really not the focus for tonight, I guess, but it does seem like there's been a push to labeling as the ticket of entry to services, which is probably not the intent of the program that Bruce Bonathon started up. But it does seem to have been a consequence and almost inevitable one. And Graham, I must confess, I'm actually not that familiar with adventure therapy, but it sounds like it is something that the relationship would be hugely important in. It's like something that the person would do as a way of sort of relating to you as the person overseeing the therapy. That must be hugely important as you connect to the young person in that process. Yes, Steve, people, I think, make the assumption that adventure therapy is about jumping over cliffs and out of aeroplanes and down whitewater rapids. In my experience, the young people we work with have been scared for most of their lives. They don't need to be scared anymore. That can for a small number of people be really useful for most people need to find out what it's like to be safe in relationship and to have someone who will protect them from harm. And so when we go out and do adventure, it tends to be fairly like adventure. I mean, we do take people out sailing. We will take them canoeing and those sorts of things, but it's about making sure that they feel like we're going to look after them. We're not going to make sure they're not going to get hurt. And it's an opportunity for us to show care. So when someone's on an abseil cliff and they want to go to things, first of all, I teach them the words about how to refuse while maintaining dignity. Thank you, Graham. I'm not abseiling today. There's no means no, and they would have a lived experience of telling me at six foot to white short haired male that they're not going to do something and me to say, absolutely, you're in charge. There's no means no. I think that's a useful story. The other thing is, I think we need to show young people that like with the harness, et cetera, on the on the cliff as to follow that example for a bit further. They see me making doubly triply quadruply sure that they're safe in the harness, their helmet fits, everything is set so that they are as protected as possible. And then I'm showing them in very small steps, what they can do and how they can withdraw dignity. So there's lots of opportunities in adventure therapy to show care at a range of levels. It's not just in the things I say, it's the things I do. I provide all these sorts of things. It's a very rich environment. So there's pretty much every young person is going to find something going on there that helps them to understand the nature of the relationship. And adventure therapy generally involves more than just one on one, not always. But that means that you can then have, I might be more interested in the relationship between two young people than I am in their relationship with me because that might be the therapeutic thing that I'm seeing there. Or like I said in the other before, we've had this a number of times a different so the organization has a number of youth workers. And the number of times they've said that the best thing that happened is that someone, a stranger stopped and talked to them. A dog or something came towards them and the young person was intimidated by the dog or kids in the park came up and offered play with the young person we're looking after. Our job is to get out of the road of those interactions or to help those interactions become ones that are negotiated safely. And the young person then has a lived experience of what these random interactions can be like because their experience of random interactions is usually quite threatening. So I don't know if that helps talk about adventure therapy, but it's not about the activity as Matt said a lot about the relationships. There's also the relationships with country with bush with I like being on water it's soothing. It might be relationship with my body because when I'm canoeing and I push the paddle this way it goes that way and I can feel that I'm working in tandem with the equipment that I've got and with the other paddler. I must say Graham I'm absolutely delighted to hear that in your work, somebody refusing to do what you asked them to do is seen as being a good thing in the medical model that be like labeled as non compliant or non adherent or resistive or something like that. I'm really quite quite taken by that idea so thanks so much. I'm also taken by the psychiatry registrar in the chat box who agrees with Matt that the DSM is not fit for for purpose I would encourage that person who I won't name to maybe get through the exams first and then pursue that line of conversation. Because unfortunately the college does seem to adhere recently firmly to the DSM. Bethany I'm intrigued what Graham was saying and also what Matt indicated about trauma having a huge impact in people's lives. You must see a lot of this in the groups you're particularly refugees who come from a place of fear you talked about the people from Africa who have seen this but is that something that you sort of have to try and wind back in people who have come from such shocking environments. Yeah absolutely I mean the first and foremost we're there to create a safe space and to build a trust rebuild a trusting relationship which is obviously one of the first things that is damaged with young people with trauma. And by in doing that part of how we approach using creative processes is actually to allow once once someone is starting to feel safe and connected to allow them to take some creative risks and to actually have some agency in in what they're doing and part of being based in a school and working in that way is also really helpful because and again it comes back to that sort of label is it useful to have the label of trauma and form care where it has been useful in a school setting is in terms of giving teachers and the people who run the day for these young people and who hold space in a different way for them throughout the day in the classroom. Giving them language and and and compassion around how to approach young people's behavior and learning needs when they've been significantly affected by trauma. So it's partly the work that we do in the therapeutic space that's all around creating safety and building relationship and connection and allowing a young person to to reflect in process allowing them to regulate themselves you know and using creative methods. You know it's great from a sensory integration point of view might sort of old OT hat comes out and you know you're doing things bilaterally and you're you know you're using all all your senses and it's incredibly powerful for managing the dysregulation that comes with trauma. And really again you know as Graham thinks that it's not even always about unpacking the story we we often do hear the story in the end but that's not the purpose you know really it is about building trust making someone feel safe having a relationship and allowing them to regulate and then become available for learning because if you're sitting in a classroom where the environment is not you know a trauma informed one and the teachers energy and the classroom energy is really you know. Difficult for a young person to manage there's no way that they can learn you know it's hard enough for any person to be trying to learn a new language. Often these young people have had absolutely no education or such significant gaps in education that they're you know they're building a whole scaffold they're learning how they're learning student behaviors. They're doing all of this at the same time as you know all of this settlement work and all the acculturation so creating those classrooms that are also able to help young people regulate having teachers that are able to model how to be steady you know and how to make someone feel safe and to understand what might be driving behavior and what might be blocking learning all of those things you know really work together. Thanks Bethany I would certainly encourage people to go back and review the recording of the first webinar. If you didn't see that one because we had a teacher there give us some really important guidelines on what to do in the classroom setting. And I see that Graham's also got a resource on that that I think we'll ask him to pop in the under that tab I mentioned earlier on teacher resources about complex trauma and associations that could be a useful thing as well. Now a number of people have been posting questions in the in the question area mainly about not being able to hear the webinar but there is one question which has come through that relates to the topic we're talking about. And that one I think I'll direct to Matt and it is from Alex Mojina who asks what type of psychotic symptoms do you most commonly see with people who have experienced trauma. What what might present as the first hint that there's something going on there in that disociacotic state. Yeah that's a good question first I just want to refer to that registrar from a trauma in for perspective he said he agree with me. I think we have to be really careful as a broader community that we can work together around how we change things in our systems I don't think it needs to be one expert or one discipline or one professional. I would encourage as a registrar to speak out about this and seek support and build your community which I know is a risky thing. But I think if we get into practicing in ways that aren't trauma informed will never go back if we're not careful. And so it's not about yeah but but in terms of psychotic symptoms I mean or disociacotic states I think the analogy I would give you is that everyone on this webinar will know what it's like to feel some anxiety in their life. Right, so some people have heart palpitations some people have sweaty palms some people will talk too much some people need the bathroom. Some people will be tired some people you know whatever whatever your anxiety experience of living isn't that's just a living experience not a disorder thing. Well, my theory would suggest that altered states that we currently called psychosis are just another form of them. So there is no kind of great themes you can you can look at voice hearing and the hearing voices movement has been this credible movement started by Marius Roman and Patsy Hague, who was a psychiatrist and a person who had voices so you know from its origin it came as a lived experience, expert by experience expert by profession position as a unison rather than separate. And, and the evidence around hearing voices seems to be that if, if you dissociate it as a child you're more likely to hear voices than if you didn't. So the trauma isn't necessarily the indicative in the indicator of what's whether you're going to hear voices or not. There's no doubt about that but I think a way of a way of understanding it perhaps Bernard Gurren's work as a professor here in South Australia saying people respond to bad life situations with the options that they have. And if you don't have any other way of experiencing your experience, it comes out how it comes out so if you're sat in a room with someone and you don't feel up safe with them in a consultation let's say a classic consultation, and you don't feel safe. And eventually you might start looking around the room for exit strategies or you might wonder if the alarm things of camera or you might wonder if the windows possible to break open and we might start saying and I'm talking fast you know, we might start saying gosh is that a paranoid state of, you know, because the professionals say oh you can leave when you want, but the person's not experiencing that. And their behavior is what we label psychosis. So I think it's very hard to say these types of traumas might lead to these types of experiences. Because if we if we can, from a dissociative perspective we're saying in this relationship that reminds me of an unsafe world that I've been brought into in some way. I'm going to put between me and you what is what keeps you away from me so dissociative credit comes from the idea of dissociation which means to set ourselves at variance. So the idea of it is that if if I'm hearing voices or shouting at something that you can't see, you're going to stay a little bit further away from me. So probably we can then start to think about when someone's telling us these so called psychotic states, eventually we'll hear them tell us exactly why they needed those states to be in place and why they had those forms of psychosis. Does that, does that make any sense. It actually leads me to something that I was keen to find out from Graham about whether there's something that goes on in the adventure setting with people who really don't want to be here but they feel an enormous amount of expectation to complete a task or something like that. But Graham you might have something a bit different to talk about in response to what Matt just said. I'll go to the point you just raised Steve actually about tasks. So I don't think this is a peculiar to adventure therapy I think any experience that involves doing things in the in the normal world. Outside is the same. And that is that if you're going to do something you're going to do something that's sort of constructive there'll be a sequence that you need to go through. And so there'll be a start point now in my world it might be putting up a tent you know you get the tent you find the space. Step three is you you take the sticks away and make sure there's no and step four you roll it out and angle it and step five you put eggs in a step six foot poles. And you've got to be able to maintain the sequence and get through all of those different steps because otherwise your tent doesn't go up and it's quite obvious that it's not going up. And so when Matt was talking about somebody who's having an experience where there's lots of things going on for them all at the same time. And things might be conflicting with each other and it's not necessarily making sense in the work that I'm doing that they I can continue to help them go back to creating this sequence. So they go through and they put it all together and they get a result at the end that is the same as everybody else would get. And so this is what it's like to normally complete a task. This is what it's like to maintain a line of thought through a complex problem that I'm trying to solve. It's not particularly threatening. But then if we do enough of these tasks where they have that they complete these action sequences. Ultimately, I'm hoping that we can start introducing them to things when they want that are somewhat daily stress or type events so that they can maintain the sequence. And they can keep collected. They can keep themselves from having too many parts trying to do things all at the one time and they might be able to move through that sequence in a more orderly sort of fashion. Which is not to say that one part of a person is better than another part of a person using the parts language here Matt will probably throw something at me. But I think the being able to be to get through life in steps that make sense to a destination in small things is really important and adventure is just takes people out of their normal place to do that. And something that's really quite interesting. It's quite different. They can have that experience like, oh, how does that work when I'm trying to be in the class at school at the same. So that's what I see adventure therapy doing is it gives people in to be really ultra normal in this unusual place and then take that being quite normal in their processes back to the normal environment. Kind of that makes any sense at all. It does to me I don't know whether either Matt or Bethany wanted to make any comment on what Graeme just said Matt you've got something. I was wondering what Bethany thought really. Yeah, look I think absolutely all of those opportunities for success and and sequencing and bringing in all of the stages of development that often get disrupted by trauma and giving people the opportunity to move through some of those developmental stages that they might have missed out on you know is incredibly valuable. And whichever way that happens, you know, in whatever format whatever the task is at hand, you know, I think it's really powerful in my work, you know, with young people, you know, a refugee background. Many of those young people have never had the opportunity to play and they've never had the opportunity to use their imagination or to think from a different perspective that they've been in survival mode. You know, their their childhood development has been so disrupted that they actually have so many things that they need to catch up on, you know, and if you bring that back even back to them, they're really, you know, the old the old OTS stuff. It's things like actually getting to use your hands and, you know, use your body and develop different coordination and skills and have those opportunities to integrate. And, you know, to have that experience is really powerful. And it doesn't always mean that they need to tell their traumatic story, you know, sometimes just being and being creative or if it's outside and being engaged in nature and doing that in a safe relationship in a safe way is actually incredibly healing. And we don't always need to go through and unpack every part of the experience. That's that's not the value and the therapist looking, you know, to to understand and be able to, you know, make sense of this story. That's not where it's at really in my experience. So being creative can be so important. I'm picking up on a question from Geraldine who's asked whether you can direct her to any evidence for art therapy as an intervention as it would really help getting support from insurers. Or is there obviously going back onto evidence, everything from cannabis to laminectomies. They seem very interested in what the evidence is for this actually being beneficial. What about art therapy? Is there a body of literature that shows a beneficial effect? Look, there absolutely is. It's growing. I think the difficulty is always being that, you know, you're trying to quantify something that is, you know, a process that is happening on so many levels. But with such complexity and it actually doesn't want to be put in a box. So it's difficult to to always come up with the empirical kind of numbers that people are looking for. But there is really a growing body of research in the resources that I've, you know, shared to go out to people later. There's definitely links to a number of different websites where you can access quite a lot of, you know, fairly recent research. I think part of what is really helping build a case for creative therapies is our growing understanding of how trauma is held in the body and how, you know, sensory processing and the impact of the nervous system and how regulating your nervous system and all of that research fits incredibly well with actually using creative methods to approach trauma. But yeah, on, you know, the HEAL website and different, you know, the Anzacata websites definitely have a lot of links to current research. But of course, just to finish, though, I would say it's really, really hard to get money for creative therapies. So it's not an easy path. And, you know, it has been a really long, long journey and an ongoing journey trying to get funding for the work that happens, you know, in this space in schools, particularly. I should just let people know too that the control room here has been like Houston when Apollo 13 went round the wrong side of the moon or whatever happened. It's been huge activity and we're told the audio is now stabilized. Particularly people are hearing us a lot more clearer now. Any problems, please do let us know. But I am going to pick up on another question that's come in this moment from Pauline Enright down in Hobart, who's asked about the three stage treatment in this area is gold standard looking at safety and stabilization, followed by processing the trauma and then reintegrating or reintegration. Is that something that people see is necessarily a required linear sort of process Graham, if you've got thoughts about that? Thanks Steve, it's and it's a good question. And I would say like 80% of my answer is going to be yes. But also, we need to think about when it may not work. The phase treatment that I think it's you said Pauline is talking about is well known in the complex trauma literature safety processing integration. Integration tends to mean integrating dissociative dissociated parts into one cohesive sense of self. That's what the clinicians in the complex trauma world I tend to be talking about. I'm a youth worker. I can't do that. For me phase three integrations of integrating this what we've learned from this experience so that I'm more functioning in the future. It's not about integrating parts of the self although I think those things happen incidentally. But it's not linear. No, people aren't linear. They don't move nice and neatly. And when you're talking complex trauma, they tend to be diving off into alternative ways of dealing with the world that work really well for a bit. And then they dive into another part of this response work really well for a bit and then this response work really well for a bit. So they tend to be quite chaotic in terms of what they look for in order to help them get through various problems, which speaks into that dissociated point. So any linear things are going to work. They need lots of repetition going back to safety, back to safety, back to safety all the time because that's the root cause of the problem. So the phase treatment is sort of all the best option. But I think everybody who uses it knows that you're doing phase one, phase one, two, three, one, three, three, one, two, three, one. And you're just constantly all through every moment you're coming back to that sense of safety with the person that's helping you at the time. And yeah, I teach in the adventure world, what we see is when you get a group that don't know each other and they come together, it seems to take about three days on a camp or the third session if it's a weekly session. And you seem to have a group that's feeling a lot safer that you can see it in the tone of their voices that laughter has a different quality to it. And so you get the end that you go, okay, we've done this three times, they seem to be feeling safe. Maybe we can move into more of a processing and experiencing more excitement in their life in these sessions. But as we're doing that, going up bigger hills, going down faster rapids or whatever, we immediately we see them not cope with back to safety again to ground the back to that point and then we can move on. So the three phase process I use, I've changed it a little bit for youth workers who don't do memory stuff and the integration work doesn't work. But on the whole, it's well recognized. However, I should say, there are the other PTSD literature and there's a totally different body of knowledge here, which is not very receptive to dissociation, generally speaking, tends to think these are the prolonged exposure advocates. And I don't think you can clearly tell I don't think it's appropriate for the complex trauma space, but exposure therapy seems to work quite well for some people with PTSD. But I've seen in the literature, you've got people in a complex trauma space saying exposure therapy can be very harmful because you know, talking about trauma is traumatic. So why would you do that unless it's really essential? And people in their prolonged exposure therapy kind of perspective are saying, if we don't go and talk about the trauma, they're going to be stuck in this, this horrible disorganized world and we need to get through the narrative of the trauma. And the two things are actually quite in conflict at their most extreme. Most people seem to fit somewhere in between that. And so the phase process and I'll stop in a sec. Safety processing is usually the telling of the story. Integration is how do we bring the parts together? Most people are following that kind of a sequence in a spiral kind of fashion. It's just people like me who are unable to talk about the past. Don't do any of the memory exposure. I need to ask though, Graham, do you find that that actually assists you in being able to not get engaged with that area? Your focus is very much on the youth work rather than necessarily delving into the sort of psychotherapy aspects that are other people's domain. I think when I tell people that I'm not going to ask them about their history, there's this big sense of relief quite often because it's hard to talk about these things. So I think that helps. However, I've got some friends who are talk therapists and work in this space and they also say, I'm not going to ask you about your history. You tell me when you're ready or if it's important that I'm not going to pursue that, certainly until I get to know what's going on for you. So they have a similar sort of conversation, but they are actually able, they're skilled enough to go into that land. But the relief of not being made to tell that story seem to be a fairly common experience. That's interesting. I can see the conversations really sparked off some conversation in the chat room. I'm not going to claim that I know who Gabor Marta is, but I'm taking a punty as a Hungarian psychologist just based on his name and a quote that's come up. It's not, it's not what's wrong with you. It's not necessarily what's happened to you, but it's how you have responded to what's happened to you. That seems to be where people are being encouraged to focus. Matt, does that quote resonate with you? Yes. I wanted to also just refer to, was it Geraldine or Pauline's thing and the three phase approach? I suppose I'm sitting here thinking it's probably convenient and comfortable to have organised ideas about working with trauma. And honestly, in my experience, that doesn't exist. And I know others will disagree with that, but so I used to teach the three phase trauma approach. And now I just think it's, I get, I don't mean to say that what you said isn't true, Graham, I can feel that. But I think there's some just crazy bits in the way we come up with theories and then we're all, we all learn them and go along with them as if they're fact. And I, and I say that for a number of reasons. The first reason for that is I am a survivor of childhood sexual abuse and various other traumas. I'm not going to go into it, but it's been fascinating at the age of 41, disclosing the childhood sexual abuse in the church and experiencing that journey over the last seven years. It's been absolute carnage. And it hasn't felt anything like, like a carnage in an all right way. Like I don't mind it, you know, like I'm like, well, that's what it is. But the idea of it fitting into any of the models I've ever read is quite peculiar. Right. And so it's included talking to random people on the train. It's included talking to therapists, it's included talking to my GP, working through with my wife, talking to one of my oldest children, you know, just all these things. For me, it's impossible to tear apart which parts that have been useful in which way, not to say therapies kind of a place. What I would say about gay boys quote and he's a psychiatrist just so we know is is yes it is how you respond to I think we have to be careful in trauma reform environments that we don't fall into the traps of the diagnostic models where we and behavioral models where we blame people for their responses. And I'm not saying that's what he's doing at all. But I think that's some of the dangers of these models is that we say that we've delivered a model and a person hasn't responded. And they get exited from services, or they have had their little lot of funding or what have you. And I. So, I suppose, ultimately, I would finish my little ramble here by saying Graham, I've heard you say today and when we did the pre thing that you can't do the therapy and talk to people about the past. I don't agree with that. And I think you do talk to them about all of their lives in the in the relationships you're having. And I know that's a little bit abstract, but I kind of think it's really important that you can go and ask someone about did this did that happen, did that happen. But people are telling us what happened in their lives. And I think that idea is an inherently trauma informed position. People present to us their lives. And I would much rather present my life to someone where it feels okay to do that and then not shy away and say they can't do trauma work with me because they are doing it when I'm in that space. It's really complicated. Absolutely. How do you respond to that, Graham? You're not going to make me a therapist, Matt. I don't want to be a therapist. It doesn't work. I sort of agree, but I see it as my advice to my youth workers is don't talk to the kids do stuff that helps them to replay the things that might have happened in the past that didn't go well and replay it in a way that actually has a good outcome where it doesn't go into the same sort of experiences that happened. So I'm listening. I'm trying to talk but not through my voice and not through the specific memories but through the actions that we're having now. There might be, well, they have to be somewhat similar to some of the things that happened in the past, but not the traumatic abuses for sure, but there's the relational or there's a risk in terms of how close I'm standing to this person on this other side. When they're in a, in the absence of the gear, they stand very close and quite happily, but if they were to do that in the normal world, it would feel really weird. So you see, I'm going through a situation where I'm very close to someone, a very powerful person, very close to a young person. When they're feeling very stressed, but I'm making sure that they have power, that they get the same note and that I'm listening carefully and that it goes, the outcome is good. I'm not going to say I'm replaying the trauma, but it's not through me talking about the past. It's me making sure that experience has a different outcome and a different quality to it. I've got a question from Matt though. You said Matt at the age of think 41, you declared some of the things that happened to you in the past and what I've seen in the literature is that a lot of people don't receive treatment either through diagnosis and not getting an accurate diagnosis of what's happened to them until around their late 30s and 40s. I'm also wondering whether with neural pruning and plasticity and whatever else it's going on, that people have managed to find enough safety in their life that they've got themselves together enough to actually think about those things that happened in the past and not have to run away from those experiences in their mind. Does age and time growing up and gathering your resources make you more available for a therapeutic experience later in life, do you think? I think, here is Bethany's ideas, she's working with young people as well and I think for me we're talking about something to do with the idea of maturity in terms of broadened experiences, environments and context. I'll just give you a very basic example. What's it like to introduce the fact that you've been sexually abused as a child into a 15 year marriage? I'm not sure that's any more or less confusing than being a 15 year old having your first consenting sexual experience and that reliving traumas of an earlier child. I mean, that makes sense. I think we're trying to find answers sometimes for things we can't and for me if I return to the idea of a trauma-informed approach, the only thing, if you and I were going to spend time together on this, but if we were going to spend time on this, I guess we would discover what it sounds like between the two of us and then see if that was useful and could be felt in other relationships out there. And I don't personally take the view that it's any easier or harder as a young or an older person. I think it's contextually just so different. And one of the problems for me is I'm 47 and I work with some young people and so I've got these opinions of how my generation would have done their 15 year old life. And so then I kind of, that's how I layer on how complicated it is or not for them. And so yeah, it's very tricky. I don't know the answer, sorry. It's a good conversation though. I'm thoroughly enjoying this, but there has stimulated quite a lot of chat on the side about people talking about what happens when you're working with somebody who can't remember the trauma. People have been talking about the body keeping score, that quote about there being, I guess, physical manifestations that the body keeps track of even if you can't cognitively remember them. But Bethany, this must happen quite a bit in your work, I would have thought, with people from refugee backgrounds. A lot of the traumas occurred very early in life. What are your thoughts about that? How do you work with people who can't verbalize what happened to them? Absolutely. And I guess that's where we definitely were from that sort of sensory point of view in that sense. Being able to tell the story in itself is not the be all and end all. And somebody may have, you know, start to remember things later in life. They may never, but absolutely they are carrying that in their body. And for children who are still in that survival mode, even though they're in a completely different context, being able to learn to regulate is the first step in that sense of safety. And also to be able to just start to sit comfortably with a range of emotions and start to differentiate the difference between being afraid and just being annoyed or the difference between disappointment and, you know, absolute heartbreak. Sometimes, you know, young people or anyone who's experienced trauma can't really appreciate just the kind of nuances. All of those feelings can be really overwhelming. All of them can really take them back to somewhere that they are, you know, absolutely, you know, in that trauma response. And so being able to regulate, being able to take risks, exploring ideas, and just, you know, drawing and painting and image making, creating, I mean, it's such a deep thing within all humans, whichever culture you're from. And just having the space to actually allow your subconscious to be a little bit free and see what comes out and then approach that with curiosity and with support and with empathy and some playfulness and the ability to make mistakes and then rework it. You know, all of these things are happening all the time when you're sitting in that sort of creative therapeutic space. And so actually being able to tell the story of what happened or even knowing what happened is not always, you know, necessary or useful. And I guess you have to think through in terms of that idea about at what age and when people's development does not follow that chronological age, you know, that we think of. And so really it's more about understanding from my perspective, it's more about understanding where someone is kind of developmentally in their life rather than, you know, at what age and understanding the safety that they have around them to actually sit with those really difficult feelings and sort of open some of those boxes up. Thanks, Bethany. I should acknowledge a question that's been asked. I won't name the person, but just on that topic talking about thanking Matt for sharing what he shared with us and also saying that they too come from trauma in childhood background and they're often fearful to mention it in their workplace for fear of judgment, despite the fact that they feel that makes them more understanding of their carers and clients background, and that they're navigating all this in their 40s and the 40s is not a good time to be navigating anything much new I suppose but thank you to that person for their comment but Graham I can see your your eyebrows are telegraphing you've got something to to ask Bethany I think. I do that comment though Steve does make me pass another one on to Matt about field workers. I think there's something in there to be explored as well particularly given the mental health plans that are being circulated around different state governments at the moment and field workers are very high priority for them but not necessarily recognise that either might have the skills to be able to help people who have similar problems to them so maybe Matt can talk about that in a sec but I'm this is great I've got these two experts I can talk to and everyone else that's just got to listen. Bethany I want to ask you about embodiment and embodiment of trauma and harm and how you might work with that and going back to the question about not being able to remember things and the idea that the body might remember something that the brain can't and it's stored in our muscles and in our posture and our ability to reach and balance and core skill all that I spoke to my physiotherapist who was doing some massage on the table and he was telling me sometimes he's massaging people who have a history of adversity and chronic trauma and he will just be talking to them about normal things not about the history at all but he'll be massaging he says every now and then some of them will just start crying because he's released some sort of tension that links to something that happened in the past I was wondering what's on that as an OT. Absolutely look absolutely and I've experienced that myself you know in therapy with people not that I'm actually definitely you know that that sense of that you know nerve being touched and something you know some sensitivity in them that that they were previously sort of unaware of or just not expecting and so a lot of what we do includes you know we're working with our breathing we're working we do stretching we're really lucky to have in the heal program an art therapist who has yoga training as well so all of us make use of a range of all of those things often with kids when they come in and they've had a big cry and they've told you you know some difficult thing that might be nothing to do with their previous history it might be the fact that they didn't do well on a test or something else but it just it touches that nerve and they have a really big brief response you know often what we're doing what I would be doing with them after they've had their cry we talk about why it's so good to have a cry and so necessary and then we might you know give our hands a massage with some really you know got a lots of little oils and and lotions and lovely smelling things and I have a little spray in my room which is like my little magic mist and we spray it and take three deep breaths and we do things like use our hand to and trace then and trace that breath with that hand so that we're concentrating on the feeling of our finger on our hand at the same time so lots of things to ground you know to ground and center and to and to learn that you know those those trauma responses those anxieties and those that distress it will go up and but it will peak you will survive it you will you know regain some sense of safety and it will come down and so the the therapeutic space where we are is really great for letting kids get you know have small tastes of that allowing themselves to express a difficult emotion allowing them to see on the page in front of them or in the sand tray depending on what we're doing or in the clay model that they've made to see that really difficult scary thing and then to actually do something with it and to experience those emotions and that physical sensation that goes with them and then get through it and and come back to that sense of safety but absolutely using you could just do body work you don't have to you know in you know from my experience that could easily be your therapeutic approach and it would it would be healing. Thanks Bethany and we will be talking quite a lot about physical aspects in the third and final webinar in this series but you have straight into a question that area asked about dance movement therapy, where they've described it as placing their bodies at the center. And I think what you were just talking about was the importance of some physical activity or physical approaches I guess to exploring this is that something does dance therapy sort of come in your realm of activities. It does not mine personally you wouldn't want to see me try and do dance therapy but definitely seeing yeah helping young people move is very powerful. Music is incredibly powerful and therapeutic and there are definitely people who have come and run programs through here at different points using dance and using drama as well and and definitely we've had we have music therapy not just at the moment but usually we have a music therapist. And it's such an amazing way to to connect people really quickly and to actually just give an experience of joy and get some dopamine going you know and bring some the cortisol down a bit you know sometimes it's a really it is really effective especially with adolescents but you know across the across the whole lifespan you know the activity that helps to regulate all of those neurotransmitters and actually yeah give a sense of joy is really important and really valuable. Joy sounds fabulous and it's it's brought Matt off mute what are you going to tell us about joy Matt. Oh joy is great isn't it. But I suppose I want to. I always feel like I'm kind of party pooper but I suppose I want to say something about the body and trauma. I want us to. I want. I want me to stay responsible in not making up facts out of what may or may not be. And I'm not saying anyone is. But I think the literature is very keen on the body keeping the school you know the book in self type book, but. Obviously that's not a new discovery. So I've certainly supported people said to be psychotic with labels of schizophrenia to Nunkery the the the traditional healers that come down from the API down to South Australia and watched them find. The body that are manifesting as trauma and related to other experiences and move them and so so that's obviously an ancient ancient experience from the indigenous peoples in this land that I know in other indigenous places but. I also think it's a bit like psychedelics and I know this is taking us into another area, but you know psychedelics means the manifesting or bringing forward what was present in the mind. It doesn't mean the drug creates the image. It allows us to have some one of the dilemmas for me of the psychedelics movement in trauma and I'm thinking about it through trauma is that. When someone sits with a therapist and takes these drugs and comes up with a framework and a formulation of what there's manifesting in their mind that can very quickly be taken as absolute. And I think we have to be very, very careful that different sensations in the body could well be manifestations of representations of trauma but could also be pins and needles and I don't mean to be flippant. I mean, we just we actually don't know is my view others might disagree, but we actually don't know. So I think trauma in the body and psychedelics are two areas where we're there's a real risk that we say, oh this is the words are used to describe this experience therefore it's true. And does that give a person an opportunity to tell another narrative maybe to the same worker the same therapist the same doctor the same friend, same family member that contradicts that experience when they have a different experience of their trauma. The more informed approach is allowing the person to be consistently in control of their own journey and experience in my view. And I think there's a real danger around these areas and I so I can give you an example in practice I'm especially talking about therapies. In our suicide model, we would say that almost everyone we ever speak to who described suicide in the context of difficult life experiences will be able to find will be able to describe somewhere in their physical being where they experienced that as they talk about it. And we find it's in the chest, sometimes in the abdomen, sometimes it's other places but sometimes in the head but sometimes other places. And we've developed a model where you can use some breathing techniques and then invite that to leave their body and then talk to it, right. So you can actually talk to it and it will often tell you the stories of a person's life about why suicides there right so you essentially removing suicide and talking to it like you can talk to voices and that's a fairly accepted model now. It's no longer a search in the NHS in England, it's no longer a spooky model out there on the edge, it's something that's happening. And so you can talk suicide and it'll tell you about the adversities and difficulties and problems in people's lives. And then you can put it back into their body and invite it to share the space with the other qualities of the person right now it sounds a bit wacky and it's too short a time to go into it. It's fairly gentle, and it's a great alternative to taking MDMA or psilocybin for those that don't want to go down the route of psychedelics. But am I really saying that there's this clump in someone's body that suicide that's also trauma and I'm taking out their body. No, I'm using metaphor. And I'm trying to offer a different alternative more creative way for people to express the narrative of their lives. And we mustn't think that just because we've done this very powerful experience, it's absolutely true. It's just creating more words, more stories, more ideas for people to use to make sense of their experience. Others may have thoughts on that. Thank you for wrapping up. That's fabulous. Let's maybe now hear from Bethany, your final thoughts about what we've talked about tonight. I'm really grateful to have been able to be part of the conversation and I've found it really illuminating for myself as well. And I hope that it's been useful to other people. I think really, whatever your modality is, whether you're the youth worker, the psychiatrist, the OT, the art therapist, the nurse practitioner, whoever you are, it's about being an authentic person and that very old OT terminology around therapeutic use of self. And I think you've got to be real. Whatever your modality is, you've got to believe in it. Your client or your patient needs to believe in it too. You need to be working towards a shared goal. And the other thing we didn't end up talking about so much tonight was about how we communicate with other practitioners. And really for me, coming from the space I'm working in, it's absolutely to be an advocate for the young person that I am working with and to put them first, to not assume that I really know, to not assume that I have all the answers for them, but to be really tireless in pursuing movement forward for them and to meet their needs in a really holistic way. And that might be that the family actually really needs help to have a washing machine. Sometimes you have to address practical issues and it's not about just really lay on the couch and let's retrace our steps. It's actually about seeing the real person in their context being absolutely committed to understanding it to the best of your ability and to be really relentless in your pursuit of helping them feel and to help them move forward and knowing that that's going to be messy and that you're not going to see the end of the story probably and that you'll only have been a very small part of it but that what you're adding is valuable and that it's real and intentional and committed. Right Bethany, thanks so much and thanks for reminding us of that third learning objective too about the importance of communicating with fellow health professionals. It really is important to tie the whole team together. So to tie it all together the last word from Graham, thanks so much. Thank you. A bit of pressure there Steve. I think what I'm hearing people say and what was clear in the research I was doing and in the work we do is be kind to each other. Just treat people with dignity. Let's not try and understand people as a problem or a diagnosis. Let's just listen deeply to what they're doing and when I say deeply, I mean don't just use your ears, use your eyes, use your body to find out, have that interaction with people because what they're saying with their words may not be what they're telling you in other parts of their posture etc. And potentially going back to the third question, just drawing people's attention to the fact that Vision 2030 is our national mental health reform agenda. It died a little bit over COVID times but all the states are picking up on it now. So all of our mental health professionals will over the next few years be having to look at more innovative ways of working with people thinking of many theories rather than one theory when they're working with people. So they have that better understanding of what they're doing and I think it's going to be interesting to see us go from a very linear 10 sessions of this to treat that to a very different playing field which I think we're all going to be a much happier with. Thank you all so much, all three of you. We are at the end of our time now and people are signing off in the chat room, but the three of you have just contributed so much and people are saying what a wonderful conversation it's been, different perspectives, always very good to hear. So a few things just to mention before we do finish. I would like to acknowledge that Dr Johanna Lynch has done some fabulous work on the trauma-informed care webinar series. There's given a time and energy to support the design and delivery of these webinars. So on behalf of MHPN, thank you so much to Johanna. I will also ask you and remind you and I big this every time to ask people to complete the exit survey and provide us feedback on how things have gone tonight. Not so much about the crackling but about the content of what people were saying. So there is the banner there or the QR code should be there for you to click on if you can give us some feedback. Now the next webinar is on trauma-informed care, the impact of trauma on the physical body on the 19th of October. So please do come along to that one. You will receive communication from MHPN about this webinar and a link to the recording of it. There are also the podcasts that are released on a fortnightly basis in the latest episode is in the first person peer worker expert by experience. So really important topic there. So before I close, I'd like to acknowledge the lived experience of people and carers who have lived with mental illness and who continue to do so now in the present. So thank you to everybody who has participated tonight. There is an attendee or one of our three fabulous panel members. So thank you all and wish you a very good evening. Good night.