Assessing for Trauma
Not every referral comes with a clear or accurate referral reason.
I’ve worked specifically with teens for many years. As I began crafting my assessment I quickly learned that in many cases, if I don’t ask, they don’t tell. The teens I see are often referred for problem behavior or depression, but I find, through a comprehensive assessment, there is so much more.
I usually speak to the teen individually prior to bringing the parent back. Since the teen is my client, I really want to work with them from where they are at – their world view. I also want to develop rapport. I can’t tell you how often teens talk about past therapy and how they were told what was for them, but they felt as though the therapist never listened or heard their story. I’ve often heard from the teens that the therapist just worked with their mom.
Before getting into the assessment I let them know I have a lot of questions, but I ask them so I can begin to try understand how things have been for them. I also explain that the questions help me begin to formulate the types of things we could possibly do in therapy that may be helpful. I also explain the limits to confidentially and that they never have to answer any question I ask – they can choose to pass.
I start with the basics: school, friends, who the child/teen lives with. I ask what their teachers are like, and how they’d describe their parents and siblings. I let them know that I also have some personal questions that I would like to ask, and I remind them that they can skip any question. I let them know that I also ask because so many kids and teens I see have experienced these things. I use the Childhood Trust Events Survey as a guide, which can be found online. I used to feel scared to ask questions like these. What if it upsets my client or scares them? What if they say yes it did happen? I’ve used this set of questions for years and have a ton of positive stories about how asking has improved not only rapport but proper diagnosis and treatment.
Let me tell you a story. I was working with a female teen referred for depression, previously in therapy and on antidepressants. We were working through the questionnaire. It asks about bullies and about the loss of a loved one, and for these questions she said she had not experienced this. I asked the question, “have you seen a friend killed?” She began to cry and shared her story, which she had not shared with her previous therapist. When I later asked why she had not shared, she said, “she didn’t ask, and I didn’t know how to bring it up.”
It’s no surprise the antidepressants weren’t working. She was experiencing Post Traumatic Stress Disorder, which was causing her to feel out of control and depressed. She wasn’t sleeping because of the nightmares she was experiencing and could not stay in class a lot of the time.
A thorough assessment is vital. So often when I ask about being touched in a place they didn’t want to be, they tell me – some who have never told anyone before. Asking says to the client, “I can handle this. I want to know. It’s okay to talk about this here.” Now, rather than focusing on the running away, I can focus on and treat the trauma, working to normalize the young person’s response, dispel myths, and teach about the sensory experience.
I am sure you can see why having this discussion with the child or teen without their parent in the room is important. Many sexual assault survivors will never tell their parents, but they will tell their therapist, and they will use therapy to work through what happened. (Side note: Child protection is not an appropriate call if a teen is sexually assaulted by a peer. They can only intervene if the perpetrator is a parent or caregiver. A teen has the choice to report to the police or not.) If you never ask, never provide that open door to tell, the child may never have the opportunity to get the interventions that could assist in their healing. Please open that door; invite the child or teen to tell you about all of their experiences. It makes a world of difference in their treatment.
Kelly is the author of the TLC program, "Teen Empowerment Manual" an evidenced-based, researched group program designed for adolescents who have been exposed to domestic violence.
TLC also offers a selection of assessments in the online store.
About Kelly Warner
Kelly Warner, LMSW, has worked for Turning Point, Inc. in Michigan for the past ten years as a child advocate, prevention educator and more recently as a child and youth therapist. She facilitates domestic violence groups and provides individual counseling sessions for child and teen survivors of domestic and sexual violence. She was instrumental in the inception of the Macomb County Domestic Violence Council’s Children and Youth Task force. Kelly has provided training on the topics of child witnesses of domestic and sexual violence, dating violence, sexual assault and gender socialization. She has a Masters degree in social work from Wayne State University where she also received her bachelor of social work. She has provided training on the topics of child witnesses of domestic and sexual violence, dating violence, sexual assault and gender socialization, and has a Masters degree in social work from Wayne State University. Kelly is the author of Teen Empowerment: A Structured Sensory Intervention Program for Teens Exposed to Domestic Violence published by TLC in 2010.
To schedule a training or consultation, please contact firstname.lastname@example.org.Read Kelly Warner’s Bio