Saturday, January 20, 2018

Why Integration and Connection are so Important in Well-Being and the Healing of Trauma


Integration has been central to my work for over 30 years. That is as a practitioner working with traumatized children and young people, as a leader and manager, as a consultant and as a writer. I think integration is vitally important, whether thinking about the developing individual, family, community and societal systems. It is also essential in a well-run organization.  Most of what is included here was written in four blogs during 2015. 

The Need for Integration, 1. Integration and Connection in Well-Being and Recovery from Trauma; 2. Leadership and Management; 3. Integrating and Connecting – The Essence of Trauma Recovery Environments; 4. Why we all Need an Integration Agenda

Since 2015 I have had the benefit of returning to a leadership position. This experience has been hugely reaffirming of the importance of integration. So, I have reorganized the material and added some. I have also been inspired by the way integration is emerging so strongly as a concept in the present. This is happening on both a micro and macro level, for example, in understanding needs of the individual and the organization.

You can download the blogs here in one PDF, – please feel welcome to share. 

As well as my own thoughts on this subject, there are numerous references and links to videos and articles. There is plenty more to consider. A future blog may focus on the major challenges and resistances to Integration – what makes it so difficult? 

Here are a few excerpts from the blogs that highlight the meaning and importance of Integration and Connection.

Child Development and Attachment Child development is centred on the integration of emotional and physical aspects of relating. For this to be achieved the primary caregiver must be reasonably integrated as a person, but also connected within a wider environment. Ideally, there are positive connections with partner, family, and community. These connections provide the holding environment within which the caregiver and infant connect physically and emotionally.    

During infancy, the attunement and emotional regulation of the caregiver is central to the developmental process. Mirror neurons in the caregiver and infant connect with the detail of each other’s feelings and behaviour. The infant's neurons fire, connect and become wired. This kind of connected being 'in tune' with the other is called attunement. (Stien and Kendall, 2004) 

Moreover, it has received influential support in the last two decades from neurobiological research which has found that secure attachments produce a growth-facilitating environment that builds neuronal connections and integrates brain systems.

Secure attachment promotes neuronal connections, helping to strengthen and integrate key brain structures. (Stien and Kendall, 2004).

Connection What enables an infant’s mind, body and brain to develop is connection with others. Throughout our lives development takes place within a relational context. As Bessel van der Kolk (2014) says,
  
 Most of our energy is devoted to connecting with others……We are profoundly social creatures; our lives consist of finding our place within the community of human beings.

It could be said that human connection is the glue that enables integration to take place. Different parts become integrated through connection. For example, a person with an integrated sense of their identity can connect the different parts of their life. An integrated and coherent autobiographical narrative, which is such an important indication of mental health is one that is connected. Like a story with a beginning, middle and end, the different parts are joined together coherently.   
Networks of connections provide a potentially stronger level of support and emotional containment. This powerful network is then internalized and integrated by the child as part of his internal model. A good support network is the single strongest protection against becoming traumatized (van der Kolk, 2014). The architecture of the brain comes to represent the architecture of the social environment. 
Integration A healthy person is an integrated person. If we think of the developing brain, we can think of neurons connecting and forming integrated neural pathways. We can think of different parts of the brain, connecting and functioning together in an integrated way. We can think of mind body integration. Integration of our senses with our mind and conscious awareness. Integration with the world around us. From the beginning of life integration is interwoven with attachment. 

 If we can connect our own ongoing need for integration to the tasks we are involved with, there is more potential for growth than through anything else we could put on the agenda. We only need to think about the many ways in which better integration might benefit our own life and work. If we are working on integration, development and achievement are likely outcomes.

Separation and differentiation are central to the process of becoming integrated, so that healthy relationships are connected and separate at the same time. Siegel (2012) sums up the importance of this very well,

…a summary of the entire field of attachment in one sentence, secure attachment is based on integrative communication, honoring differences promoting linkages.

Well-Being Before connections can be achieved, safety must be established. Only when the disconnected or unconnected person begins to feel safe will he be able to take the risks involved in connecting. Once the process of connecting begins the person is moving towards integration. The foundations of well-being can be considered as safety, connection and integration. 

Trauma Among many negative impacts on the brain-body system, trauma interferes with the integration of left and right hemisphere brain functioning. Rational thought cannot be accessed in the face of overwhelming emotion. Emotional and social disconnection can begin a spiral that leads to further isolation and alienation. On the other hand, emotional and relational connection creates a positive spiral. It leads to the conditions that bring about more connection.  

Recovery If neural integration is as Dan Siegel (2006) says, ‘at the heart of well-being’ and trauma disrupts healthy development, then recovery is about completing the process of integration. A person or any living system that is integrated is one where the different parts work together in a functional way. For individuals, there is mind-body and sensory integration, and an effective balance where emotion and reason complement each other. The same analogy can be applied to social groups, such as families, teams, communities and societies.
In the healing of trauma, just as in ordinary development ‘it takes a village to raise a child’. Or as Perry and Szalavitz (2006) said, “What maltreated and traumatized children most need is a healthy community to buffer the pain, distress and loss caused by their earlier trauma. What works to heal them is anything that increases the number and quality of a child’s relationships".
The aim of recovery is to create connections that can be personally integrated. Connections can be thought of in relation to oneself, between internal and external worlds, in relationships with others, and the wider community. The level of connection that traumatized children need means that those who are involved in the therapeutic work must be highly attuned. Emotional attunement is receptive to connection and creates secure attachment. 

Recovery from injuries perpetrated in a social context must occur in a social context. These centers, responsible for healing, must become therapeutic communities where recovering is more important than control, and compassion and empathy drive out fear and coercion. (Farragher and Yanosy, 2005) 

Therapeutic Models Strong models are ones where everyone whatever their role is involved in the process of integration and connection. For example, a therapist or carer might be doing what Dan Siegel recommends – working to improve the integrative functioning of a child’s prefrontal neocortex. While the task of the organization leader might be about building integrative connections inside and outside of the organization.  
Einstein’s view that ‘example isn’t another way to teach it is the only way to teach’, provides a good principle for how we approach the task. If integration is the aim of trauma recovery, then we must practice integration in every aspect of our work.
Organizations and Communities All relationships and roles in the community were considered part of the healing environment. The role of the maintenance staff and domestic assistants were considered equally alongside the work of teachers, care workers and therapists. This is one of the features of trauma-informed environments – everyone’s role is important and therefore needs to be integrated into the whole system.

Those organizations that pay attention to the need for integration, which is far more difficult than getting one part rather than the whole to work well, are likely to become the most competent type of organization.

Neural integration is not assisted – indeed is actively impeded – by unintegrated human services which are not only compartmentalised, but which lack basic trauma awareness. (Kezelman and Stavropoulos, 2012)

I think the most important issue is learning to work together, actually, and building teams of people who understand how to do that in creative ways. Because we have all got to move out of the silos that have been put down for us by the public sector and they are often there in business, and learn how to join things up. (Mawson, 2012) 

Leadership and Management For a service to be effective, management and therapy need to be integrated successfully. Good management is necessary for therapy to take place and sometimes good management is therapeutic in itself. The same could be said about any kind of practice in the human services – it can only be truly effective in a well-managed context.

It can be argued that the key task of leadership is to provide the conditions in which organizational integration takes place.

Vision is crucial to create an inspiring and important mission. So is doing the job at hand, however mundane or unpleasant it may seem. It is the integration of the two that is critical.

Micro and Macro In work with traumatized children both the micro and macro levels are important, but it is when there is a synergy between them that there is greatest potential for recovery. For a child, this synergy would be like having a safe and attuned relationship with a primary carer, within a healthy partnership between parents, within a caring extended family, within a safe and thriving community.   

My first three parts on integration have moved between the micro level of the individual brain to the macro level of leadership, organizations and society. While this might seem a little awkward I think it is essential. We can’t consider the individual as an isolate. We are all part of a wider system. As Prilleltensky (2006) has shown, well-being is about the integration of the individual, relational and collective levels.

Both the individual and the community are 'plastic', i.e. capable of recovery and growth, however difficult and traumatic their histories. 
The network patterns of the outside world mimic a lot of the network patterns of the internal world. (Johnson, 2010) 

Postscript: A couple of days after I posted this – I saw the Ted Talk by Susan Pinker (2017), “The Secret to Living Longer may be your Social Life”. Pinker refers to the research of Psychologist, Julianne Holt-Lunstad on the factors that contribute most to well-being and a long life. Top of the list after close relationships is social integration.

References
Farragher, B. and Yanosy, S. (2005) Creating a Trauma-Sensitive Culture in Residential Treatment, Therapeutic Communities: The International Journal for Therapeutic and Supportive Organizations, 26(1):93-109

Johnson (2010) TED Talk, Where Good Ideas Come From | Steven Johnson | TED Talks, https://goo.gl/iYVldv

Kezelman, C. and Stavropoulos, P. (2012) The Last Frontier: Practice Guidelines for Treatment of Complex Trauma and Trauma Informed Care and Service Delivery, Australia: Adults Surviving Child Abuse (ASCA), http://goo.gl/t9o3lA

Andrew Mawson, Water City CIC, Connecting People, Business and Place - Water City Legacy, http://www.water-city.com/

Andrew Mawson (2012) Lord Mawson, Andrew Mawson Partnerships: APM Project Management Conference 2012, https://www.youtube.com/watch?v=EOFKR5c7-NE

Perry, B.D. and Szalavitz, M. (2006) The Boy who was Raised as a Dog: And Other Stories from a Child Psychiatrist’s Notebook New York: Basic Books


Pinker, S. (2017) The Secret to Living Longer may be your Social Life, Ted Talk, https://www.youtube.com/watch?v=ptIecdCZ3dg&t=216s

Prilleltensky, I. (2006) ‘Psychopolitical validity: Working with power to promote justice and wellbeing.’ Paper presented at the First International Conference of Community Psychology, San Juan, Puerto Rico, 10th June 2006.

Siegel, D.J. (2006) Series Editor’s Foreword, in, Ogden, P., Minton, K. and Pain, C. Trauma and the Body, New York: Norton

Dan Siegel video (2012) - How to Successfully Build an "Integrated" Child

Stien, P.T. and Kendall, J. (2004) Psychological Trauma and the Developing Brain: Neurologically Based Interventions for Troubled Children, New York, London, Oxford: The Haworth Maltreatment and Trauma Press

van der Kolk, B. (2014) The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma, Viking: New York