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NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors

Working Clinically with Children with Complex Trauma Presentations

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Jon Jureidini
Child Psychiatrist and Professor
School of Medicine, University of Adelaide

Holly Cutcher
Child and Adolescent Counsellor

Children from refugee backgrounds living in Australia have usually survived a multitude of traumatic experiences and significant losses in their country of origin or while they are fleeing. Exposed to war, persecution, extreme deprivation and sometimes torture; it is common for children from refugee backgrounds to experience the violent death of one or both parents, to witness friends and close relatives being killed or injured; and to suffer extreme poverty, starvation, physical injuries, and disabilities. Some children are born in prisons or conceived in prison because of the rape of their mothers; others are raised in an orphanage or other residential care. Subsequently they are prone to post traumatic stress disorder and other psychological problems. Some may have complex presentations including complex PTSD.

In this Clinical Master Class held on 17 July 2023, Dr Jon Jureidini explored how to tolerate and respect young people’s distress. There is strong encouragement to consider such distress as illness or disorder, so that parents, therapists, and teachers are prone to label and intervene rather than sit with distressing feelings. We do better to trust children’s capacity to survive and benefit from strong uncomfortable feelings; be more respectful of the time and space that is required to do so; and tolerate and manage the anxiety we experience through not intervening. In providing scaffolding to see young people through their distress, the meaning of their experience will often emerge, ‘without any irritable reaching after fact and reason’.

Holly Cutcher, a STARTTS Child and Adolescent Counsellor, shared an example of engagement and early therapeutic work through a case study of a young boy whose experience of prolonged exposure to war and flight from his home country took place against a pre-existing foundation of abuse, early abandonment, and complex grief. Her case study highlighted some of the challenges of engaging and containing the surrounding system and finding a space for attunement and connection amidst internal and external environments of deprivation and chaos.

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