How to Engage the Extended Family in Trauma Treatment
It Takes a Village to Raise a Child
It takes a village to raise a child is an old African proverb. It means that a child needs both the immediate and extended family to overcome adverse experiences like trauma and to grow up in a safe and secure environment. Unfortunately, traditional trauma treatment often only includes the individual child. And if the family is involved, it is only those members of the immediate household living under the same roof. The extended family of friends, ex-spouses, relatives, or institutions (schools, probation officers, child protective service workers, etc.) are rarely engaged or actively involved. And if they are, their roles and function are not well defined. Therefore, the key questions are: “Why does this happen?” and “How do we overcome this problem?” Using the FST| Family Systems Trauma Model, we propose answers to both questions from Chapter Five of Treating the Traumatized Child: A Step-by-Step Family Systems Approach.
Why a Lack of Extended Family (Village) Involvement?
- The Fear Factor Therapists will state, “Family therapy with just the immediate family scares me to death so if you add the complexity of the extended family, I am really overwhelmed.” As therapists, we will use treatment modalities that we are comfortable with and have received training in. Personally, in graduate school, all my training from my professors and field instructors involved individual treatment and case management. There was little to no formal family therapy training. As a result, all my cases received individual therapy until I sought out post-graduate family therapy training. Early in my career, it was the fear factor of failing and lack of family therapy tools that kept me from treating the entire traumatized family and its village. Over the last 32 years of my career, I have seen this same fear factor and lack of family therapy training prevent other trauma specialists from actively involving the extended family.
- Lack of Step-by-Step Tools Once the extended family is engaged in trauma treatment, “now what?”. What do I do with a room full of six or more people that may include relatives, neighbors, friends, or institutions who often despise one another and only need a slight provocation to implode right before my eyes? And then what do I do to clarify everyone’s roles? For example, what is the grandparent’s part in being supportive of their grandchildren and the parents? When I first started actively engaging the village, I was both petrified, and I often failed. When the village was present in my sessions, I just lacked the step-by-step tools to know what to do and require a written plan.
Step-by-Step Tools to Involve the Extended Family (Village) in Trauma Treatment
Within the FST Model, we provide the necessary step-by-step tools to engage the extended family in two ways: (1) A Diagnostic Village Handout, and (2) Village Trauma Playbooks.
At the Family Trauma Institute, we discovered an interesting finding. When we asked a parent if they had an extended family or village that we could contact, the typical answer was either “no” or “they will not come.” As a result, at the end of the first diagnostic intake session we now ask the following question after providing the Diagnostic Village Handout:
“Based on our goals and your stress chart, who do we need to come to the next meeting? [List them.] And secondly, based on what you saw today, who was not here that should be here? To make these questions super easy to answer let’s take a few minutes to fill in the village handout together. As we do this, it will become clearer who should come.”
A Diagnostic Village Handout can be prepared as a handout or prewritten on a flip chart page to be filled in together with your family during the intake session. This handout provides an easy on-ramp to get the family to reveal (a) who the villagers are by first name to prevent the natural resistance of “I have no village,” and (b) ask if that person is considered an essential supporter for the child and/or family or not, and where that person lives. The location of the villager is important because depending on how significant that particular villager is, the FST therapist can invite that person into a session via speakerphone or through Skype if he or she lives too far away to attend a meeting in person.
In sum, the Village Handout breaks through resistance by framing this exercise as SOP (standard operating practice) that all families complete at intake. A picture is worth a thousand words and both the therapist and family are often surprised at how many villagers they have as they fill out the handout.
In business book, Good to Great, the author, Jim Collins notes that when confronted with any problem, we should shift the decision from a “what” question (“What should we do?”) to a “who” question (“Who would be the right person to take responsibility for this?”). Translated into treatment, this means that the therapist should spend more time on the “who” decision before launching into the “what” of treatment. As Jim Collins (p. 128) writes:
Leaders of companies [the therapist] that go from good to great, start not with “where” but with “who.” They start by getting the right people on the bus, the wrong people off the bus, and the right people in the right seats. And they stick with that discipline—first the people, then the direction [italics added]—no matter how dire the circumstances.
The FST therapist is the leader that must get the right people on the bus and in the right seats before good to great FST trauma treatment can begin. Otherwise, there is unrealized potential of support for the traumatized family and the knowledge of which non-supportive villagers need to be neutralized.
Village Trauma Playbook
After the FST therapist uses the Village Handout to identify the top extended family members or institutions to participate in future sessions, the next step is to use what is called a Village Trauma Playbook to clarify everyone’s roles within a who? what? when? where? and how? framework. The playbook illustrates an example of this type of trauma playbook. During the upcoming FST Membership Webinar on Tuesday, May 28th from 1pm–2pm EST, I will present a chronically stuck traumatized case of 15-year-old Leon and his extended family of villagers:
- Leon, aged 14, the identified patient
- Mary, single parent mom
- Luke, Mary’s boyfriend
- Jackson, Leon’s biological father
- Rick, the local pastor
- Jim, Leon’s juvenile probation officer
- Susan, the families CPS Case Worker (child protective services)
- Salvation Army
- United Way
- Scott Sells, the FST consultant
- Jennifer, the FST family therapist.
Jennifer, the FST family therapist, asked me to consult with the case. She had been treating the family for over a year. Leon was involved in both the juvenile justice system for stealing a car and CPS was involved because Leon was currently living in a home without utilities or a bed. If these matters were not resolved immediately, Leno and his four younger brothers and sisters would be removed and placed in temporary foster care. The mother, Mary, was clinically depressed and unable to look for employment and her boyfriend was also unemployed. At first glance, the situation seemed hopeless.
My case consultation session would be the first to involve the village of all 12 people. As Figure 1 illustrates, the first “now what?” task to unstick this traumatized family was to bring everyone together to co-create the first ever Village Trauma Playbook called “Get the Lights On and a Bed to Sleep On.”
In other words, before any type of psychological counseling could be successful, Maslow’s Hierarchy of Needs or physiological needs of food, clothing, and shelter had to be addressed first. This is why the case was chronically stuck. Jennifer, the family therapist, was: (1) conducting therapy for over a year with just Leon and/or mom but no village involvement; (2) There was psychological counseling around mom’s depression and Leon’s acting out behaviors but little physiological interventions around basic needs, and (4) there was no pre-written plan to outline a clarity of roles to address unmet basic needs first and psychological needs second.
The process steps of how to first assemble the village and second write a successful Village Trauma Playbook will be explored further during the upcoming May 28th FST Membership Webinar. However, it is important to note that this simple trauma playbook ignited the fire needed to mobilize the village, not only to secure the utilities required, but also a bed for Leon to sleep on. In turn, the risk for CPS removal was decreased, and the mother’s depression got remarkably better because she finally had the support that was both clear and measurable with accountability. Leon, in turn, started performing well in school and attending his juvenile probation community service obligations. Without the extended family and the playbook, it is unlikely that Leon’s family would get unstuck and move forward.
About the author
Scott P. Sells, Ph.D., MSW, LCSW, LMFT, is the author of three books, Treating the Tough Adolescent: A Family-Based, Step-by-Step Guide (1998), Parenting Your Out-of-Control Teenager: 7 Steps to Reestablish Authority and Reclaim Love (2001), and Treating the Traumatized Child: A Step-by-Step Family Systems Approach (2017). He can be contacted at firstname.lastname@example.org or through LinkedIn and Facebook.