Running head: PROCESSING TRAUMA USING THE RELATIONAL CARE LADDER

Processing Trauma Using the Relational Care Ladder

Frida C. Rundell Ph.D., LPC.

The International Institute for Restorative Practices

October 2017
PROCESSING TRAUMA USING THE RELATIONAL CARE LADDER 2

Table of Contents

Abstract................................................................................................................................3

[Title Here, up to 12 Words, on One to Two Lines]............................................................4

[Heading 1]..........................................................................................................................4

[Heading 2]......................................................................................................................4

[Heading 3]..................................................................................................................4

References............................................................................................................................4

Footnotes..............................................................................................................................4

Tables...................................................................................................................................4

Figures.................................................................................................................................4
PROCESSING TRAUMA USING THE RELATIONAL CARE LADDER 3

Abstract

The process of dealing with trauma is simple yet complex. The Relational Care Ladder is based
on developmental theories across the century that create safety, structure, support and regulation
to professionals, parents and children in how to trauma proof our communities when trauma and
dysregulation in the neural pathways occur. A description of the Relational Care Ladder and the
sequential rungs of the ladder that need to be put in place before active challenging may take
place is essential. Each rung from structure to nurture, engagement and finally challenge will
identify needs at each stage; what professional proficiencies need to be in place by adults who
are responsible. Specific guidelines will be suggested at various levels of the ladder rungs.

Keywords: structure, nurture, engagement, challenge, safety, awareness, feelings,

empowerment, self-worth, attunement, competence.
PROCESSING TRAUMA USING THE RELATIONAL CARE LADDER 4

Processing Trauma Using the Relational Care Ladder

Caring for ourselves and for others takes on many subtleties. Care-givers like mothers,
counselors, teachers, doctors, nurses are re-known for taking care of others yet neglect the same
care for themselves. Recognizing how we take care of ourselves could reveal that self-kindness
is overthrown by the level of self-judgement we have of ourselves; seeing ourselves as part of
common-humanity rather than isolating ourselves when we experience extreme stress; over-
identifying with our clients instead of using well practiced mindful techniques to stablize
ourselves (Neff, 2003). The self-compassion scale is one that is recommended for all
professionals to begin this journey with (see Table 1 & 2 for scale & graph)
Then there are the clients we serve. How to identify their trauma without causing more stress for
them. The Relational Care ladder is designed for both professional and those we need to care for
(see figure 1).
The Relational Care Ladder

The rungs of the Relational Care Ladder are your guidelines in checking yourself and how you
are handling your clients, be they your children, youth, parents or colleagues. They are supported
by developmental theorists.
Structure1

Structure refers to your surroundings and environment and get the neural pathways to regulate
normally. Moving to a safer space where breathing and space are more easily accessible is
critical. The brain has signaled an amygdala alert. The hippocampus cannot handle the trigger. It
then moves into a bodily response which is known as a procedural memory.
The need here is safety. Space is critical in this phase. Safety requires a responsible adult to
make decisions. Safety for all concerned, organization of the space and being able to begin
breathing regulation are the decisions that need to be made. This could mean getting the person
to blow out (using a paper packet, a balloon); clearing the area of people; removing the person to
a quiet environment. Not invading them with questions or a need to respond. Staying with them
and having someone being non-threateningly present with the client. This is a drain-off period
where only quiet affirmations and validations work. The aim is to achieve normal nervous
system regulation.
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Professionals need to regulate the structure they find themselves in by using circles, impromptu
groups, or one –to-one discussions on a regular basis. Here are some rituals that help structure
children and youth to expect and be predictable within your structure:
Greeting at the beginning of the day and farewells at the end of the day must be regularly done;
introducing proactive circles that share feelings, fun experiences, acknowledging support gained
through the week; learning a new word each day and collectively using it through the day for
fun.
Nurture. You will recognize when you move into the nurturing phase of the Relational Care
Ladder because the client is able to respond to the affirmations or validations you have made
directly to them. The nurturing phase requires an adult to be present, provide security, continue
affirming and whenever the emotions get too overwhelming go back to breathing.
Here the opportunity to gain awareness becomes important. Awareness that the client knows it is
okay to go and ask to splash their face because they are feeling uncomfortable; or to remove
themselves from a trigger that is causing them a level of discomfort.
Within the brain, implicit memory happens to be those emotional responses and procedural
memory patterns that arise when the client least expects it. This is be apparent (see figure 2).
Providing something that soothes is helpful to some e.g. walking, squeezing a rubber ball, having
a mantra to say to themselves during this time. Yoga, exercise or some sequential movement that
allows regulation of breathing to take place helps the procedural memory to feel secure again.

To gain awareness into what has happened requires someone to guide them to recognize the
sensations in their body. Getting this timeline right is important in the healing of trauma and
knowing what to do during the trigger. Move to any images that pop up in their minds through
their senses. Then ask about what behavioral response became apparent as they were triggered.
Was there any affect in themselves of sadness, anger, disgust or fear. Then proceed to what does
it mean to them when these sensation, images and behaviors arise. Use the mnemonic SIBAM
from Levine’s work. (Levine,, 2015) see figure 3.
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The major aim here is to create awareness within the person of what is happening within the
bodies at the time of the trauma trigger. Allow time for expressing the stormy first draft (SFD)
where they can orally or in writing let off steam. This may not be pretty. Do not take it
personally. The SFD must be torn up or shredded. Then only can one present in a non-
threatening way to someone in the room. The oxytoxin that happens when you are with someone
in a non-threatening way is important. Once the client becomes aware of where they are and that
the sensations in their body have calmed down, you may be ready for the next phase. They are no
longer in hyper-arousal or hypo-arousal (figure 4).
See listening map and Awareness map.

Engagement. During this phase having a conversation about the experience is more readily
available to the client. Once neural pathways have been regulated, feelings may be easily
expressed and processed. The aim is to allow the integration of the implicit memory of trauma to
now merge with the explicit memory. Using the experience and the sensations felt, expression is
essential for integration towards healing to happen. The five restorative questions are helpful
tools here.
Compassionate witnessing is particularly affective at this point where support is rallied together
in a non-threatening way. See figure 5. Gaining access to what the central issue is through the
feelings is a process that compassionate witnessing provides (Weingarten, 2003). Identifying any
of the five developmental anxieties allows the client to externalize what the issue is and how they
want to address it in future (Brendtro et al..)
Emapathy and support allow the joy of companionship, being in the “now” moment and getting
attuned with others. Expressing feelings becomes the primary focus. Vulnerability becomes the
moving dial as the client shares their inner experiences with a non-judgemnetal group of people.
Emapthy becomes apparent. (Figure 6). Providing insight into the triggers.
Enagagement could use art, music, journalling or any other creative process where focus on
doing allows space for chatting about feelings.

Challenge. Once a client has been able to work through each of these phases successfully,
working with their own trauma or others will become easier. They have learned to stay with the
painful experience. Recognize where it is in the body. Create a place where they sharing their
experiences are priority. Now challenge them on a procedural memory or emotion they would
like to change. This may relate back to the central issue and pattern of behavior . Recognizing
how control through micro-management or being the rescuer the firefighter) stops you from
taking care of yourself. (Figure 7.)
Teaching new tools and applying them to real life situations becomes the challenge.
The primary purpose of challenge is to grow as a person through competence, mastery and
playfulness. The need is to empower self within your environment. Making the emotional
triggers and the procedural behavior more explicit allows healing to happen (See figure 8).
Games that challenge avoidance, withdrawal or attacking self and others are applied in this
phase.
Role plays, skill training exercises are helpful.
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Relational Care Ladder Examples at each phase.

Structure.
• Structure requires Safety, Organization and Regulation.
• Developmental role of attachment is essential for safety and trust, inner knowing
and self-acceptance, response flexibility (Bowlby,1998); Schore & Schore,2008;
Baurind,1991; Makela,2014; Makela & Hart,2011; Porges,2011;van der
Kolk,2005).
• Children are:overactive, unfocused, over-stimulated, and have a desperate need
to control the situation.
• Parents are: Poorly regulated/disorganized, have difficulty setting limits or being
a confident leader, rely on verbal/cognitive structuring, and are over or under
stimulating.
• To change the negative patterns of a child who has experienced relational trauma,
it is necessary to provide a similar direct, interactive, and sensitive emotional
experience that challenges old patterns and expectations (Shore, 2003; Hart,2008)
• The brain needs the adult to meet the child’s younger emotional needs, on
finding ways to calm the dysregulated child, and on creating feelings of safety for
the traumatized child (Perry,2006; van der Kolk,2005).
• Predictability, child seeks confirmation of even maladaptive internal
representations. Communicating with the child to help him or her change their
internal representations and provide the necessary development support
(Makela,2014).
• The right hemisphere develops in the first two years creating body and spatial
awareness, and social and emotional awareness. This in turn promotes attachment
and emotional security during early stages of development where the child sees
the outside world.

Nurture.
• Security,
• Self worth,
• Stress Reduction.
• The role of trauma affecting memory is critical when caregiver’s response is
indifferent or neglectful, critical, harsh judgement or shaming.
• Goldsmith,2007; Bowlby,1988; Makela,2005; Weiss,1990; Panksepp,2012.
Children who experience lack of nurturing Overactive
• Aggressive
• Anxious
• Pseudo-mature
• Lone ranger
• Compulsive self-reliant
• Parents who need nurturing are Dismissive
• Harsh
• Punitive
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• Difficulty with touch

• Unable to show emotion
• Relational Traumatized children need Soothing, hands-on experiences that are repetitive,
rhythmic and rewarding ( Perry & Szalavitz,2006).
• Appropriate levels of stimulation to the areas of the brain that are involved in affect
regulation.
• Must have respect and appropriate experiences of good touch experiences.

Engagement.
• Engagement
• Joy of companionship,
• attunement,
• now moments.
• The regulation of emotional affect
• Porges,2011; Trevarthen & Aitkem,2001; Stern,1985; Winnicott,1971;
• Siegel,2006; Hughes,2007; Fonagy et.al. 2002; Geller & Porges,2014.
• Children who need engagement display withdrawal, avoiding of contact, anxious/rigidly
structured and uncomfortable with others.
• Parents who lack engagement demonstrate the same characteristics of personal
discomfort with crowds.
The psychological affect may manifest itself generations later.
• Parents who lack engagement are disengaged, preoccupied, inattentive and out of sync
with the child. They rely primarily on verbal engagement and simply do not enjoy the
child.
• The social impact on children later in life is that they become followers; over- identify
with others they get involved with, to fulfill the need; tend to be excessive people
pleasers and consequently end up procrastinating due to over commitment on their part.

Challenge
• Competence
• Mastery
• Play
• Neural plasticity of the brain
• Williamson & Anzalone,1997; Hart,2008; Stern,1974; Porges,2011; Geller &
Porges,2014;
• Relational trauma shows in Parents have lost the capacity to play (James, 1989).
• Play serves as a less intense form of affection for a child who fends off adult caregiving
following trauma (Hugh,2012).
• Broken relationships due to trauma Insecure Avoidant attachment
• Insecure Anxious attachment
• Disorganized attachment
PROCESSING TRAUMA USING THE RELATIONAL CARE LADDER 9

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PROCESSING TRAUMA USING THE RELATIONAL CARE LADDER 11

Figure 1

Relational Care Ladder

Frida Rundell Ph.D.(2017)

Client Needs Professional Competencies to be used.

CHALLENGE Competence, Mastery, Play.

Empowerment

Feelings ENGAGEMENT
Joy of companionship, attunement, now moments.

Awareness NURTURE
Security, Self Worth, Stress Reduction.

Safety STRUCTURE
Safety, Organization, Regulation.

“SNEC”

Figure 2
PROCESSING TRAUMA USING THE RELATIONAL CARE LADDER 12
PROCESSING TRAUMA USING THE RELATIONAL CARE LADDER 13

Figure 3
PROCESSING TRAUMA USING THE RELATIONAL CARE LADDER 14

Figure 4

Figure 5.

HYPERAROUSAL
HYPER-AROUSAL Defending
Emotional reactivity
Hypervigilance
Intrusive imagery
Obsessive/cyclical
AROUSAL cognitive processing

Optimal Arousal Zone

HYPOAROUSAL
Flat affect
Inability to think clearly
Numbing
Disabled orientating
and
Defensive responses
HYPO-AROUSALL
l The image part with
relationship ID rId4 was not
found in the file.

Levine, 1997; Siegel 1998)

PROCESSING TRAUMA USING THE RELATIONAL CARE LADDER 15

Figure 6
PROCESSING TRAUMA USING THE RELATIONAL CARE LADDER 16

Figure 7
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Figure 8.

SELF
Calm Clear
Curious Creative
Competent Courageous
Connected Confident
Compassionate

MANAGER FIREFIGHTER

EXILE
(Swartz, 1995)
PROCESSING TRAUMA USING THE RELATIONAL CARE LADDER 18

Figure 9.
PROCESSING TRAUMA USING THE RELATIONAL CARE LADDER 19

Figure 10

Procedure for dissolving an

emotional schema into coherence
1. Retrieval: Discovery
Find and experience the symptom-requiring
schema vividly, emotionally, bodily.

2. Retrieval: Integration.
Find and experience vividly some other,
contradictory living knowledge.
PROCESSING TRAUMA USING THE RELATIONAL CARE LADDER 20

Figure 11

Procedure for dissolving an emotional

schema into coherence
3. Transformation: Juxtaposition.
Experience 1 & 2 simultaneously.
Both feel real & both cannot be true
4. Transformation: verification.
Symptom-requiring schema is de-potentiate,
lacks realness,
cannot be re-evoked; symptom stops.