7 Reasons Why Your Trauma Cases Get Stuck
Your traumatized family can retell their trauma story by using an experiential technique called strongholds to bring about deep healing.
Using the FST | Family Systems Trauma Model, I have discovered the following top 7 reasons why our trauma cases get stuck:
- Undercurrent(s) Selected Not Ideal
- “Who?” (Village) before “What?”
- No Reframe to Tether Playbook
- No Troubleshooting or Role Plays
- No Typed-Up Playbook/Contract
- Not the Best Problem Symptom
- No Safety-First Plan
As a consultant for 10-year-old Dexter and his family, I go through these 7 reasons with the family’s therapist and how the case got stuck. Watch the rich discussion we have and my recommendations.
You can then use these same reasons to identify and locate when your cases get stuck. Let’s watch
Family Trauma Step-by-Step Tools with Dr. Scott Sells: Episode #5 – 7 Reasons Why Your Trauma Cases Get Stuck
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What came to this is that I asked Scott if he would help me on a stuck case. That’s where I’m at and I have a little video that I presented to Scott and that’s where we’re at today.
Yeah, thanks Michael. The case that you presented is, and I’ll have you comment on this before we go ahead and do a deep dive into it, is about Dexter and his family. I’ll just give some bullet points and then ask you to talk about the case a little bit. Dexter is 10 years old. Really presented to me that this case… there was co-founding variables that made this a very difficult case. There was aggression where he’s been having a lot of problems in school where the school actually wants to, they’re pressuring the family to have him go to another school.
He’s got a lot of attachment problems, especially with mom and somewhat with dad. The parents are definitely not on the same page here, and there’s also some marital tension you feel. My hypothesis is that Dexter might be the middle of that. And the village has not really been engaged. Michael, what are a few more things that you have to add about this case that made it very complex?
Well, Dexter, as you pointed out, is 10 years old, and he’s been in treatment for probably half of that life. During that time, the family has been through multiple providers with minimal success. When they came to me, they showed me a hand written not by a PhD level psychologist who said, “In my 30 years of experience, this is the worst case I’ve ever seen.” That kind of took me back. So basically, all the treatment providers were saying, he was treatment resistant. That’s a few things that I could add to that.
I said don’t give me an easy case here, and you didn’t. The other thing is that when you have multiple treatment failures, it makes them more difficult. This is because when you introduce a playbook to a fresh family who hasn’t had multiple treatment failures, they’re more curious about it. They’re more open too, “Oh, I’ll try it. I mean, we’re not burned out yet.”
But when you present an FST trauma playbook, they’re like, “been there, done. It doesn’t work. Yeah, buddy.” So I’m going to be presenting a bonus strategy around a reframe, because reframes are very powerful for stuck cases. The more stuck in the mud a family is, the more you got to take a jackhammer… before you even introduce the playbook, you’ve got to grease the wheel. You’ve got to almost prepare them before you present the playbook. So they’re like, “Oh my gosh, it connects the dots.”
I knew going in, that when we worked on this tough case together, that I had to present a reframe and a strategy that would get them almost shocked in a good way. Does that make sense? That is did you feel like we had to grab them with a reframe, which we’ll present in just a minute?
Yeah. Especially as what you’re going to hear is dad’s resistance. I think that’s the piece that I was struggling with, Scott, and how to get Dad on board. I think the reframe that you’re going to hear was pretty potent to get him on board.
Yeah and the dad challenges me with it. You’re going to see. It gets pretty hairy. I don’t always get the honor and privilege of taping sessions where it’s so messy. I think people like mess. I think the members who are on the phone, I’m hoping that they’ll, kind of mix it up with me and be like, “Oh my gosh, what would I do if this happened?” So anyways, it should be a lot of fun today. So, let’s get started here.
There is really seven reasons, I’ve come to appreciate over my career, of why cases get stuck that I’m going to share with you, Michael. I think the case was stuck, and you can agree and disagree with me. Number one, the undercurrent selected by the therapist that I’m consulting with, and it’s even with the cases I work with, is sometimes they’re not an ideal undercurrent.
I remember one case where the undercurrent was Maslow’s hierarchy of needs The family had been in treatment for over a year. The therapist had been doing psychological work with the mom and the boy individually, but the family didn’t have their lights on. They didn’t have utilities. There was no bed for the boy to sleep on. That undercurrent was not ideal. They had chosen an undercurrent around attachment before the undercurrent that the basic needs were met. So that’s as an example of a case that got stuck because the undercurrent was not correctly selected. One of the biggest ones they see in our field is “who” before “what” is not addressed. I mean, do you think (and I’ll pause here) do you think that was a big issue for this case?
It was definitely an issue. Yes. Can you hear me?
I can hear you.
Definitely. And part of the reason why is that the family had sequestered themselves. They wanted to have help, but they were ashamed because if they ask for help, their kid would then be a hellion, so to speak, for everybody else, which has been the case. They have burnt bridges in the past with babysitters and with other people. They were, I guess you would say, shellshocked for lack of a better word. They were hopeless at the time that you came on board.
So I think, yeah
And even to the point where… Didn’t he break another boy’s collarbone too?
Right. Well got to a point where he was used to bullying other kids. Dexter was rough with his play and then he got to the point where he’s bullying this four year old kid and he pushed him down with such force that he broke his clavicle.
Yep. This is very common when you have really stuck cases. It’s a catch 22. They burned out their village. They also have a self-fulfilling prophecy that it won’t work. And if you’re not careful they can convince you, the therapist, that it won’t work. From their experience it won’t work. So you have to say to them, “I agree with you that it might not work, but can we try as an experiment?” So you’re going to see in a video clip how right off the bat when we have the villagers there, I start off with giving them a question to compliment the parents. Because it has to be a difference. That makes a difference. So in order to make these playbooks work, you have to have “who” before “what.” If you don’t have the right people on the bus, the playbook still effective, but it’s like an antibiotic of half the strength.
That’s one thing I wanted to talk about.
The other thing I see here is that there’s no troubleshooting or role-plays. That’s going to be the technique next month in November where we’re going to take this case all the way through and you’re going to see at the end in a preview of upcoming attractions how critical troubleshooting is. And that without the playbook with you practice the troubleshooting or the role-plays you, you’re basically sending these parents off to slaughter metaphorically. Because you’re giving them a playbook but they don’t know the delivery. So much in mental health, and I’m guilty of this, is tied to cases getting stuck or failing because of this one.
There’s no typed-up of playbook or contract. It’s all verbal. It’s not predetermined. You’re going to see the mom talk about being intrigued by having something typed up. You bring to the session and not this blank piece of paper, which is, “Oh, let’s start from scratch.” You actually have a draft that they can use so they have hope.
The other thing is, is that it’s not the best problem or the symptom. The problem that you take what the kid is coming in with and it’s too difficult to do it first. You’ve got to get quick victories, low hanging fruit, and there’s no reframe to tether the playbook. So the family doesn’t really buy into the playbook. They don’t know, what’s in it for me. It’s just like, “Oh, go ahead and try this.”
Well again, if it’s a cure, but I don’t think I need the cure, then why would I use the cure. That’s a huge piece. Then number seven, no safety first plan. These were the areas that I think were causing problems with this case. I don’t know if you agree or disagree. Undercurrent selected not ideal. We didn’t have the village. There wasn’t a good reframe and there wasn’t a lot of troubleshooting. Would those reasons be comparable to what you thought, Michael? Or would you agree or disagree? And it’s okay to disagree with me.
Well no, I would agree. I would agree. I had attempted to get the village on board previously, and that was rather difficult. So, that was good. I agree with the reframe because they weren’t quite bought into it. I might talk a little bit maybe at the end that I don’t know about no troubleshooting, because I cut to the chase and that was a mistake on my part. Then the undercurrent, going back to number one, I thought I was in the right place, but it just wasn’t quite the right hit, you know? And that’s what was important to me. I saw the aha moment was like, “yes, this is, this is more of a hit emotionally with a family that will work. They’re buying into it.”