I Became the man I feared the most

I Became the man I feared the most understanding the traumatic origins of violence & building compassionate responses.

Our aims § To acknowledge the presence of violence in the lives of people we work with (and in our own lives). § To recognise the functional value of violence § Explore the trauma related aspects of violence § Consider how to respond to violence as a manifestation of trauma

The context § We work in human services § Community support – residential – custodial – hospital § So we have to think about how we respond to human behaviour…as humans behaving.

§ This needs to include the way we respond to incidents of violence § Not just our physical response to violence § But our psychological mind-set. § Some things to think about…

Consideration 1: Violence and harmful acts are fundamentally human

Violence has been seen as a form of entertainment….

We justify violence…

We use our Intelligence to perpetuate suffering

Consideration 2: Violence is functional

§ Fight or Flight: basic biology § Communicate needs & meets those needs § Establish social status § Manage intimacy And violence is likely to be effective at least some times.

Consideration 3: Attachment and relationship history

The attachment challenge § To form an impression in the mind of the (m)other § To form an impression that is positive and care eliciting attachment trauma Inability to form an impression in the mind of the (m)other Form an impression that elicits indifference Form an impression that elicits cruelty

Attachment trauma § When we are unable to form an impression in the mind of the (m)other that elicits care and security § Then we may need to develop an externalising reaction to manage security in relationships § So the child develops an impression in the mind of the (m)other that he or she is (potentially) harmful. § We use trauma induction to deal with trauma: re-enactment

Consideration 4: Impact of trauma

§ Kerig and Becker (2010) Exploring range of different pathways between trauma and offending (e. g. ‘acquired callousness’ and ‘featurelessness’) § Waxman et al (2014) “antisocial personality styles are predicted by physical abuse and avoidant and schizoid by emotional neglect”. PD parallels abuse § Dodge et al (95) children with a history of physical abuse likely to: § misread social cues and see hostility § have positive evaluations of aggression, § and readily access aggressive strategies in response to interpersonal problems

Garbarino (99) trauma can change morality that justifies victimizing others I became the man I feared the most

Consideration 5: The power dynamic

Submissive and obedient (Milgram/Zimbado)

So what are we trying to achieve? It is our job to create a favourable impression of ourselves in the minds of our patients so that they can experience power and authority in a non abusive and nurturing manner We do this by creating a social culture that values everyone who lives and works within it and by providing effective and humanistic treatments This includes our physical interventions

So how do we develop a compassionate approach to physical interventions?

§ Acknowledge our capacity for violence: the human threat system § Mentalise your patients/clients: understand their history § Look behind the violence § Utilise the expertise of your patients/clients

Reconsideration One: Understanding our threat system Evolution has changed us.

Our new brain doesn’t always get on with our old brain

Getting Smart: New Brain Competencies

Getting tricked: New Brain Competencies dwelli ng New brain imagining selfworst criticising outcome New brain etc… brain Emoti on level Time Old

Reconsideration two: Holding our patients in OUR mind § Early separation/rejection – we are not stable attachment figure § Repeated experiences of neglect/abuse – expectation of more abuse § Behavioural difficulties from early age – experience of being challenging § Multiple care placements, often institutional – experience of poor endings § Conflict with social and community norms – rejected and marginalised

THE INTERNAL WORLD OF SOME PEOPLE WE WORK WITH WE NEED TO UNDERSTAND HOW WE COME TO BE REPRESENTED IN THE MINDS OF THOSE WE WORK WITH…

So we need to HOLD in mind that we are working with people who come from a culture where… § Fear is more common than safety § Suspicion is more dominant than trust § Cruelty is more prevalent than compassion …we need to earn trust and respect from the impression that we create – not from the power inherent in our role

Emotions that fire together wire together: What's the true emotional experience of the person in front of you?

Reconsideration three: Look behind the violence there but for the grace of God

Reconsideration Four: Develop patient led reviews of violence: Value their expertise.

Violence § Violence breeds violence (at home, on a ward) § Always ready – “kick off easily” § The calm before the storm - “don’t know how to deal with a quiet ward” • Violence gives me power (“I don’t know how to leave a place on good terms”) • Better the devil you know (“I know how to react to violence”) • Ready for it (“We know when its coming before staff do”)

Reflections § Many of the people we work with have learned to use violence § That learning may have included significant trauma and abuse and nthier violence may reflect their desperation to feel safe. § The culture of a ward or residential setting will influence the “readiness for violence” § Ward cultures need to be “treatment enhancing” § If we really want to help men who have learned to use violence then we need to develop a compassionate understanding of how they came to learn violence.