Trust-Based Relational Intervention

by Grahame Williams

It was late 2016 – I was in Chicago Illinois for two weeks attending a Dr Dan Hughes and then a Theraplay training workshop in my search for best practice in helping attachment deprived children. I had at this point worked for over a decade in a large foster care and residential agency as well as running my own small practice as a play therapist. Prior to that I had worked as a community adolescent family counsellor in regional NSW and prior to that on a residential farm for homeless youths. I had overtime changed modes of practice, read books, been to various experts workshops and also fallen into behavioralist traps along this journey until finally seeing the light of attachment – the lack thereof and its effects on children’s behaviour, their mental health and their very existence. 

So, I read some more – Perry, Hughes, van der Kolk, Schore, Siegel (you know them – you have read them too!) All good if not great - I then created my own workshop on Reactive Attachment Disorder and have run this for years using all the best practice Ideas from the best people I knew of. I then headed off to Chicago and attending the workshops already mentioned as they are widely touted in helping in attachment. Here I met a young enthusiastic social worker who told me about TBRI (Trust-Based Relational Intervention®) and Dr Karyn Purvis and her book called, “The Connected Child” – (Purvis, Cross & Sunshine 2007). Her enthusiasm was such I just had to read it. On returning home I bought a copy and read it from cover to cover. 

It resonated with me strongly - a modality that was truly holistic in its approach, based on evidence, wrapped in common sense and often simple in its approaches in tackling the most complex of issues – children’s trauma. 

I just had to bring TBRI® to my service and so I gained a grant, I applied was accepted and after 40 hours of online training, videos, quizzes and readings I went to Forth Worth Texas to attend 5 days of lectures and hands on training in TBRI® with the experts. I had now become, at that point, only the second person in Australia to have attended and become a TBRI® practitioner. In early 2017 armed with a well set out PowerPoint presentation from the good people of the Karyn Purvis Institute of Child Development of Texas Christian University I started to train foster carers in the three TBRI® principles of: Empowerment—attention to physical needs, Connection—attention to attachment needs, and Correction—attention to behavioural needs. These three factors, first identified by van der Kolk (2005), and later discussed by Bath (2008) as the three main “pillars” that should be included in any program designed to treat complex trauma. These are (a) development of safety, (b) promotion of healing relationships, and (c) teaching of self-management and coping skills. These elements parallel the three evidence-based principles of Trust-Based Relational Intervention® (TBRI) developed at the Texas Christian University Institute of Child Development.

I started out training foster carers with one group per week (2.5hrs) over 6 weeks ( I break the principles into a series of weeks to allow participants time to practice interventions and ideas and bring their thoughts back to the group over the weeks) led to a second group of parents who were struggling with their connections and behaviours of their children and could lead to family breakdown. This led to a third group where their children were in foster care but they were looking at being restored home. 

The feedback from many participants has been nothing short of amazing. 

I was and I am still astounded in every group I run where people are willing to open their minds to a new idea, to try something different and give something a go that changes for the better do happen. 

I will leave you with a few short TBRI® stories – both successful and failures – yes I do have failures. I was having a session in the play therapy room one day – newly back from TBRI® training – and super keen to try and a few TBRI® principles into action.  A young boy – 7 years – demands something which I respond by giving him a choice of two but he likes neither. I go up a level and say...

”Would you like a compromise then?”  

Quicken than a blink of an eye he says...

“What the f%&$ is a compromise?”

I laughed and apologised for not explaining what a compromise was (rule 1 – explain, practice and therefore they know what the hell you are talking about when it comes to the crunch).  The opposite to that was a grandmother who after years of fighting her teen grandchild she was raising ran into the room one day saying it worked! I’ve been giving him choices and compromises re eating and he not only eating better but less arguments – helping me cook and go shopping!  She’d been arguing for years cooking what she felt was best and getting know where and suddenly something so seemingly simple was allowing him to have a voice, some control and it was working.  Sadly she told me the story before the group was there so I made her tell it all over again once they were present – it is these success stories that in real time often get people from being just a listener in the group to trying it as they have heard someone’s success story.  

I’d started a new group for parents who were finding it hard to cope with their children. for various reasons. and found that 7 out of 8 of the participants were warming up to TBRI®, my delivery and attempts to make them feel safe and open up. One lady however sat stone faced and gave little away. She didn’t engage, didn’t dispute anything – didn’t laugh at my best attempts to be the next Carl Barron – didn’t – well just didn’t. Session 1, session 2, session 3 – same thing.  I was close to breaking out a song and dance routine in session 4 when bam!  The empowering principle around sensory issues hit home.  Evidently she’d been taking one of her kids to an OT (occupational therapist)  for quite a while without any real great understanding of why – and felt he just had fun doing the various activities (welcome to my world of play therapy).  Suddenly it made sense to her and the next week she brought in all sorts of sensory items for people to test out and be familiar with. She was a different person from that day till the end. I think there is an OT somewhere that needs to thank me too!    

A single parent of 8 children of ages ranging from 2 to 16 found everything just too much. Dismissive of their needs, preferring to tell them to go away and not engaging with them – stress building on stress and just plain desperate but open to new ideas told the group after 4 weeks in how one day that week,  on a busy shopping trip one of her younger children started to dysregulate but where previously she would growl, be angry and dismissive she said she applied what she had learned. She got down to their level, used gentle touch, gained meaningful eye contact, heard their concerns, acknowledged them, and with a smile and a hug they moved on with what she said would’ve been a half hour of tears and yelling dealt with in a minute.  She had also taken to doing things as a family which involved fun and laughter and the changes it had made in that family and her wellbeing was to her credit just plain incredible.  

Trauma informed trainings come, and they go – there is a new fad, a new mode, a new this and new that and many are very good. Is TBRI® better than others – I cannot say - all I can say is that it just works.

Like anything new you must be open to it – like a parachute your mind only works when it is open. 

For over two decades Grahame Williams has worked with children, adolescents and their parents/carers as a care manager, adolescent family counsellor and play therapist. Grahame has worked in numerous settings, including, youth centres, residential care, rural community, private sector and not-for-profit agencies which has provided him with a broad knowledge of issues facing children and parents/carers. Grahame has a passion for working with children from trauma backgrounds, children with attachment problems and suffering from anxiety. In recent years his focus has been around attachment-focused therapies such as TheraplayDyadic Developmental Psychotherapy and Trust Based Relational Intervention® for which he is an authorised TBRI® Practitioner. 

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