How We Clinically Work with ACES
In this post, hear from how our Fully Certified Clinical Trauma Professional Ashley works with ACES
Review on ACEs
Adverse Childhood Experiences (ACEs) is an assessment tool used by clinicians when gathering information about a client’s history. It screens for experiences such as physical, verbal, sexual abuse, emotional neglect, domestic violence, household dysfunction, and caregiver mental illness, amongst others. On a wider scale, experiences such as community violence, natural disasters, or racism may also impact health and developmental difficulties, especially when there is a lack of supportive adults in the child’s social ecosystem. Extensive research on the ACEs have shown an undeniable correlation between negative childhood events with physical and mental health problems into adulthood. In other words, the more ACEs reported, the stronger likelihood that a client will develop issues such as heart disease, liver disease, poor diet, a diabetic condition, gastrointestinal problems, substance use issues, disordered eating, social anxiety, chronic fatigue, a depressive condition, or medically unexplained symptoms later in life. A more in depth understanding on the ACEs is blogged about on the website (https://www.yyztalks.com/blog/ace-study/).
What we do with the ACE Score
As I relate this to my practice, once I have completed the assessment, and accumulate the client’s ACE scores, thoughtful consideration is given when determining a tailored treatment approach for the client. It is important to note that I also take into account the client’s resilience factors. These include the belief that you were loved as a child, having extended relatives care for you, having clear rules in the house, having trustworthy people to talk to or help you (relatives, neighbours, educators, coaches, religious figures), to name a few. The development of a secure attachment indicates the client’s ability to foster close relationships towards friends and romantic partners, which serves as a protective factor.
Working with Trauma
In addition to the above-noted factors that go into a treatment plan, I maintain a client-centered approach by having the client establish goals for therapy. Together, we work through what the client’s desired outcome is, scale where they perceive themselves to be currently, and identify potential barriers with a strategy on how to mitigate them.
Psychoeducation is also a key piece when working with trauma. I provide my clients with a knowledge base on how trauma impacts the brain development (especially during critical ages and stages), and the autonomic nervous system (sympathetic and parasympathetic responses). Many clients find this information eye-opening, as oftentimes, they have internalized their responses as them being faulty in someway, which leads to hurtful narratives and a negative sense of self.
The next step is to resource the client. Understanding that the content of the client’s struggles will likely result in triggering material, it is essential that I provide them with techniques to ground themselves in the here and now. Additionally, we look at Top-Down and Bottom-Up interventions for self-regulation. That way, when the client is ready to visit the “then and there” of the traumatic event(s), they are empowered with the tools that are a right fit for them, and how to access support structures.
I find that these components set the tone for the therapeutic rapport. Where the client may have not had an ally as a child, we begin to build a trusting dynamic. In the event that I notice a hesitancy in the client to build that trust, I take this as an opportunity to help the client to tolerate relational stress, and model healthy rupture and repair where possible. The routine and structure of sessions also puts the client in touch with predictability and stability that they might have otherwise lacked growing up.
Moreover, with each intervention strategy or activity, I seek out the client’s consent prior to proceeding. Not only does it serve to strengthen the therapeutic alliance, it invites the client’s voice into the conversation. In working with the ACEs, when the child version of the client may have been belittled, rejected, or invalidated, consent in the safe space of the therapy setting, sets the stage for the adult client’s voice to be heard, understood, and privileged.
Closing Notes
This framework merely outlines the initial stages of trauma-informed therapy. Each clients’ journey is unique to their sociocultural context, the relationship they have with their traumatic material, and the work they put into their goals between sessions. Moreover, with a “lead from behind” philosophy, we move at a pace that is comfortable with the client.